Monroe “Puggy” Farmer – Part 2

In Part 1 I introduced Puggy Farmer and his optometric treatment for Tonya’s amblyopia when she was a kid growing up in West Virginia.  Though Tonya apparently went from 20/30 to 20/20 with her left eye, and no longer needed glasses, that was not the end of her visual struggles.  As our colleague Dr. Fortenbacher has pointed out, there is much more to the amblyopia story than good eyesight in both eyes independently.

One can’t really fault Dr. Farmer for how he treated Tonya nearly 20 years ago.  His approach reflected what was commonplace in the field.  In some ways he was ahead of his time when it came to the idea of prescribing glasses for anisometropic amblyopia in lieu of patching, as substantiated now by PEDIG studies and widely accepted.  Tonya however encountered significant difficulty when reading.  All though her high school and college years she endured eye strain, headaches, and even began to see double.  Apparently none of this mattered because, after all, her amblyopia had been “cured”.

In a review I wrote for about Sue Barry’s widely acclaimed book, Fixing My Gaze, I indicated the following:

I suspect the most revealing chapter, for many readers, will be School Crossings. In the third chapter Sue lays bare the fact that she attributes her struggles in school to undetected and untreated vision problems. She writes, “I did not discover how I used my eyes for reading until I was an adult and underwent an eye exam with a developmental optometrist”. While this may not be as profound to neuroscientists as the neuroplasticity piece of her tale, it will raise the eyebrows of a few professionals and should resonate with parents of children who are struggling in school.

Much like Sue, Tonya was told by those who examined her eyes that everything was fine.  It was not until she entered graduate school in Optometry four years ago that a Resident in Primary Care Optometry noticed that she had difficulty using both eyes together adequately.  He incorporated two diopters of vertical prism in a spectacle lens prescription and she experienced some immediate improvement.  This parallels the experience that Sue Barry had with Dr. Steven Markow, and how crucial it is for a primary care optometrist to recognize when a patient’s visual function is significantly compromised despite having 20/20 eyesight in each eye and being free of ocular disease.

In part 3 we’ll share more about Tonya, and the significance of treating amblyopia.

– Leonard J. Press, O.D., FCOVD, FAAO

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