I just finished doing an evaluation on a 14 year old girl whose mother is a COTA – a Certified Occupational Therapy Assistant. This young teen is very bright, but works incredibly hard to get Bs in school. Her mother loves to read, but her daugbhter struggles with anyting in print. When listening to others read she grasps things perfectly. Mom had attended a seminar I gave almost a year ago that discussed, among other topics, the difference between ophthalmology and optometry, and how most ophthalmologists poo-poo the relationship between vision and learning beyond eyesight. Some ophthalmologisgts will acknowledge that convergence insufficiency can make reading more challenging, but if a child wants to succeed she will. So mom was very specific that although there were both ophthalmologists and optometirsts in this practice, she wanted to see the optometrist. At the end of the examination the doctor advised mother that everything was fine with her daughtger’s eyes, other than she needed a little help seeing the board. She gave her a prescription for low nearsighted power. It turns out that this young girl is actually a bit farsighted, even more so with drops in her eyes to relax her focus. Not surprisingly, she resists wearing her glasses. But that’s not where the story ends. Mother specifically asked the doctor how her daughter’s binocular vision was, and the doctor said “Her eyes are fine”. Mother, after having attended my course, knew enough to do a nearpoint of convergence (NPC) screening. Her daughhter struggled mightily to converge, but couldn’t look at the target within the reading distance because it physically hurt her eyes to keep it single. So mother again asked the doctor the question, being even more specific this time about having testied her convergence abilities. This time the doctor was even more emphatic in her reply: “I told you, other than being a little nearsighted, her eyes are fine”.
As it turns out, this teen’s eyes are fine. It’s her vision that’s a problem. She has a significant convergence insufficiency, as mother had properly detected on screening. In a stereoscope test she uses both eyes together beautifully at distance where she sees, by the way, 20/20 letters without glasses. But at near she experiences a double vision response because of her underconvergence. In an objective test of reading, using the Readalyzer eye movement sensors, she visibity struggled to track effectively. When I reviewed the findings with mom and daughter, they were relieved but pertrurbed. Mom said to me: “I’m a COTA. I know what to look for. But what happens to a ‘regular’ parent? I would have felt initmated by the doctor if I didn’t know in my heart that something was wrong. I can’t even discuss this with my husband, because he knows the optometrist said everything is fine and he feels our daughter is just being lazy. But I know her well and she is capable of so much more. I hate to sit by and watch her settle for less, and I’m not goiing to do it any longer.”
We had a brief discussion about how some optometrists, particularly if they work in an ophthlamology practice, learn to adopt the mindset of their employers. They lose sight of the role of vision in learning, and poo-poo anything beyond the need for glasses, medicadtion or surgery. In essence, they become sheep in wolves’ clothing. Then mom asked me a question I really couldn’t answer: “Why does it have to be this way?”
– Leonard J. Press, O.D., FCOVD, FAAO