When we first saw Gregory he had deep amblyopia of the right eye. His visual acuity, or eyesight through that eye was severely reduced, even though he was wearing a contact lens to compensate for significant hyperopia or farsightedness. We projected this target onto the wall:
Gregory looked at the target through red and green glasses. Only the right eye, looking through the red filter, would be able to see the top red symbol. Only the left eye, looking through the green filter, would be able to see the left and right green symbols. What do you think Greg reported seeing?
He saw three objects, two green plus signs on the side, and a greenish looking circle at the bottom. His brain suppressed or tuned out the image through his right eye. Now, more than half way through his optometric vision therapy program, Gregory was in my examination chair last Thursday as I projected the target after he put the red and green glasses on. One of the ways we assess progress is to have baseline information that the patient only repeats during these progress evaluations. Gregory has never seen the target without the red and green glasses on, and I have never told him what the target should appear to look like when viewed through normal binocular vision. It should be a process of discovery.
Gregory’s rather was sitting in the examination room, as he always does, when Greg responded this time by saying that he saw four objects. I asked him what they were and he replied: “Two circles and two plus signs”. His father had a concerned look on his face, and remarked that Greg was a very bright, straight A student. “Do you think he understood what you were asking him?” Dad remarked. By this time Gregory’s acuity through his contact lens with the right eye had improved from 20/400 to 20/50 whole line and 20/40 isolated letters. So I was confident that he had the acuity to see that the top shape, if not a diamond (or a rhombus, as the bright kids say) was at least not a circle. So I asked him to compare the top and bottom shapes and tell me if they were the same. He said: “Not really; the top shape looks more like it has corners – so I guess that’s more of a rhombus than a second circle”.
His dad and I shared a smile, and I gave him a link to a blog posted here last year that amblyopia is not just a reduction in visual acuity. The brain acts as if it were learning disabled with processing central information such as shapes and letters through that eye, as compared to through the non-amblyopic eye. That led to a brief discussion about how this bright, straight “A” student worked very hard to achieve in school, and that reading took considerably longer for him than most of his peers. Not that there’s anything wrong with that per se, but we agreed that with each passing year Gregory was finding it harder to succeed at a high level, and putting considerable pressure on himself.
When I was Chief of the Pediatric Unit at the Pennsylvania College of Optometry, I had a graduate student who was working toward a Master’s Degree in Child Psych at the University of Pennsylvania. Her advisor was Elizabeth Spelke, Ph.D., and I helped Barbara devise a tracking test which incorporated divided attention. In deciding who we would test, she asked me an interesting question: “Why is it that we spend so much time on children who are failing or underachieving. Why aren’t we as concerned with children who are high achievers, but paying a significant price for it?