Extreme vision problems a catalyst for teaching…20/20 is not good enough


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

3 thoughts on “Extreme vision problems a catalyst for teaching…20/20 is not good enough

  1. Dr. Dan,

    Thanks for the slogan, that 20/20 is not good enough. I have been preaching this since 1950. and I am sure all Optometrists do. At least our extensive visual functional education,makes us the visual specialist
    and we should, and if we do not who will ?

    In my view the reason that humanity, equates the vision standard relative to acuity ,like 20/20, is because,that is the way the medical community,only understands vision, from the cave men days.The medical doctors are not trained beyond that standard. Even the specialist in Medicine our OMD’s have little interest in natures wonderful attempemt to have a perfect binocular two eyes visual marriage,and only considers a problem when it shows up as a cosmetic failure, a total visual divorce. Long before major binocular stress, even doulbe vision the patient would be having, a binocular visual marriage battle,such as CI and otther accommodated convergence interferances with poor performance and discomfort. But who would know not even the patient, in most cases.that, that is the problem ?

    However the health community only follows the medical direction,and the non trained in this visual understanding speciality, is and has been the preachers. After all is not 20/20 the perfect set of eyes?

    Optometry has the responsbility of using this slogan ” That 20/20 vision is not good enough” so eventually it will sink in as the public ask for an explaination, and they will learn something they never heard before,in the best of public schools,and other places of learning.

    The world is getting a little taste of what two eye vision is all about when the go to the now popular 3D movies. If they have a good Binocular marriage they will be so pleased, if not they will be complaining, in performance and discomfort, Time to see your Eye Doctor.

    Floyd D. Mizener OD DOS Phd

  2. Thank you Dr. Mizener for your heartfelt comment. And thanks to Mackenzie for bringing this message to the forefront with her video, 20/20 is Not Good Enough…For Me. Our patients can often say it better than we can! Let’s hope that the message is heard and the pubilc awareness continues to grow for these vision problems that can have a drastic impact on a child (or adult) and their quality of life. Thankfully through the efforts of COVD and the Visions of Hope campaign, this message is starting to be heard!

  3. Wow – thanks for sharing that video of Mackenzie! The production values are amazing. Thanks as well for the 20/20 isn’t good enough. The LASIK surgeons tend to use the phrase in pursuing a “hyperacuity” of sorts with optimal aberrometric acuity in the better than 20/20 region, whereas we mean 20/20 not good enough in exactly the way you described it for the purposes of learning and optimal overall visual function.

    I also like your point about using the extreme state of a condition that could have been limited in its impact if caught and treated earlier. Excellent analogy to allowing a CI to unravel. The quality of life issues can be very significant, as they were for Breanna. Very well done!

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