Caroline is an 8 year-old child who was referred to us by her occupational therapist. “Oh, those OTs – they think everybody needs therapy. She’s doing fine and her vision is excellent.” The quote comes from Caroline’s pediatric ophthalmologist. Same kind of doctor who told Christina’s parents that they needn’t look any further regarding her visual development. Same kind of doctor who never advised Sue Barry’s parents that vision therapy might aid her visual development. Think this is a concern? If a world-renowned Nobel Prize recipient can tell you that sometimes you have to search for a doctor who’s more open, so can we.
Lest you find this harsh, let me italicize this: neither I nor Nobel recipient David Hubel are saying that pediatric ophthalmologists are insensitive, uncaring, or unknowledgable. Heck, I published an article about how compassionate our local pediatric ophthalmologist was in coming to the hospital late at night to check on my granddaughter. But I’m gong to give you the rest of Caroline’s scenario because it’s an event that occurs every day, in at least one office, in each state in this country and around the world – and the picture will become clearer.
Parent: “Hi, I’m calling to schedule an examination for my daughter, Caroline.”
Receptionist: “I’ll be glad to help. Were you referred to our office by someone in particular?”
Parent: “Her OT, Lisa, suggested that I call.”
Receptionist: “Is there a particular concern about Caroline’s vision?”
Parent: “Yes, I have Lisa’s report, and under eye tracking it says incoordination in horizontal & vertical planes, moves head while tracking, & reports she sees double and the words jump while she’s reading”.
Receptionist: “Has Caroline had an eye examination within the past year?”
Parent: “Oh, yes. She has been examined regularly by her pediatric ophthalmologist.”
Receptionist: “That’s good to hear. We’ll have you request a copy of the records so that the doctor can learn more about what treatment Caroline has received.”
Parent: “I’ll have to think about that. I don’t want to offend Dr. X by telling him I’m coming here, because when I mentioned that the OT thought Caroline might need vision therapy, he got very upset.”
This seems to be a burden that many parents we see carry initially. While we don’t dissuade parents from seeing any doctor whom they please, we lean toward Dr. Hubel’s advice: If you’re afraid of offending your doctor, you probably need to find a doctor who’s more open. So Caroline’s mother did present us with the most recent letter that the ped OMD wrote to her pediatrician, and here’s what it said:
You’ll notice something interesting. The report says that Caroline has esotropia at near fixation with her glasses, but the “Impression” is intermittent exotropia. Maybe that’s a typo, and maybe it isn’t. In any event, the report says that she has done very well and that her vision is excellent. The “Chief Complaint” was mom noticing that the right (which is the eye they had been patching) was now drifting. So the advice was to stop patching and see if that was contributing to the crossing.
I examined Caroline a few days ago. Her glasses are plano (no power) in the right lens and +2.50 (a fair chunk of farsightedness) in the left lens. Her retinoscopy is +0.50 through the right eye and +2.50 through the left eye. Her acuity through the right eye is 20/20 and through the left eye hovers between 20/25 and 20/30. Her stereoacuity (two-eye depth perception for 3D), reported to be normal in the report, is only normal with the large Random Dot “E” Stereo Test. With smaller targets at near, or when I backed away with the “E” to a distance of only three feet, Caroline’s responses were at the level of chance guessing.
The OT’s report was actually more insightful. Caroline was indeed having difficulty using both eyes together at near, and had esophoria or excessive inward turning on the Keystone Visual Skills, and struggled to maintain single vision. It was understandable why she was experiencing words jump on the page. Caroline needs a bifocal lens prescription and/or optometric vision therapy to stabilize her ability to use both eyes together efficiently. It really is as basic as that, and her OT understood this better than her pediatric ophthalmologist. Caroline’s mother has found a doctor who is more open.