The Re-Launching of Christopher Walter


C1Christopher’s parents began noticing his left eye turning in during the Fall of 2012, a few months after he had turned three.  They took him to a pediatric ophthalmologist who diagnosed accommodative esotropia.  The prescription in his glasses was R eye +4.75 and L eye +5.75.  But even with the glasses on his left eye continued to turn inward resulting in amblyopia, and his father pointed out that Christopher had become more cautious after obtaining the glasses.  From December 2012 through December 2013 his parents patched Christopher’s right eye to improve the eyesight in his left eye, according to a patching schedule devised by his doctor.

Concerns were developing in school, particuarly about midline crossing and fine motor skills, which led to an occupational therapy evaluation.

OccupationalTherapy

His OT evaluation noted that Christopher was having difficulty consistent with binocular integration problems.  Through a friend whose daughter came to our practice, Christopher’s parents brought him for a vision therapy evaluation.  We found that through his glasses Christopher still had amblyopia, measuring 20/30 with the right eye and 20/60 with the left eye.  He had a constant inward turn of the left eye to a small degree that wasn’t cosmetically noticeable, but just enough to result in suppressing that eye on all sensory testing.

I projected 8 months of vision therapy, and tonight I conducted Christopher’s second monthly progress evaluation.  He is making excellent progress, and has already improved to 20/25 acuity with either eye.  Most tellingly, he is beginning to use both eyes together on certain sensory testing.  For example, on a vectographic slide he can keep targets from both eyes on at the same time, and on anaglyyphic targets he was able to keep the left eye on from a distance out to 10 feet away.  He was not able to perceive a random dot stereogram yet, but I explained to his father that this was a more artificial target not indicative of spatial judgement in the real world.  If we could get to that point, it would be a nice bonus.  As I was reviewing progress with his father, Christohper suddenly stood up on my exam chair, and launched himself with aplomb.  See that — his dad exclaimed!  I’ve been noticing that his confidence in judging space is returning!  We both shared a big smile.

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10 thoughts on “The Re-Launching of Christopher Walter

  1. Thank you to Dr. Press, Dr. Mike, and their wonderful staff! We are so pleased with Christopher’s “re-launching”!

  2. Dear Lenny,

    Thank you for sharing this case. It is time for us to get beyond strabismus as simply a problem in alignment. It is not only a cosmetic problem. An eye turn is one factor among a number of other factors, which impact a child ability to function in their world. Functions such as accommodation, ocular motor, perceptual, and attention skills must also be part of the treatment approach. It should also be noted that most ophthalmologists, who rely on a cycloplegic refraction, have a dismal record in determining the appropriate prescription. In many instances, they do not even do the refraction. It is another example that more is not always better. THANKS AGAIN for sharing Christopher’s progress. I truly believe that there are many more exciting developments ahead as he begins to reach his potential. A clinical approach focused only on eye alignment and amblyopia would not have allowed him to reach those lofty goals.

    Richard

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