Ophthalmology Referral for Vision Therapy

I’m pleased to share with you the highlights of a case referred to me by an ophthalmologst for vision therapy last month.  There are a number of different angles to this case, and I’ll begin by relating that Carol is a presbyopic female with a long-standing history of amblyopia of the left eye which was never treated.  She has been wearing contact lenses since childhood uneventfully, and as she got to be a “40-something” she used OTC readers over he contact lenses.  Last year a well-meaning optometrist encouraged her to try monovision contact lenses, with her right eye for distance and her left eye for near.  Carol’s amblyopia wasn’t deep from an acuity standpoint, as she saw 20/25 through the left eye.  But after a short period of monovision wear she began to see double. monovison Carol then went to an ophthalmologist who recognized that her fusion had decompensated into divergence insufficiency, with sufficient intermittent esotropia at distance to create double vision.  He immediately took her out of monovision and prescribed Fresnel prism for use over her contact lenses at distance.   Although Carol was better able to maintain single vision, there were still times thats he saw double at distance, and she was distraught at having to give up driving. Diplopia Driving Recognizing that he could not help her further, and to his credit, the ophthalmologist suggested to Carol that she consult with me, and at the point that I first saw her on May 4 she measured 22 prism diopters of esophoria in free space at distance, quickly breaking down into left esotropia.  Keystone Visual Skills paralleled this, with eso diplopia at distance and good fusion at near.  We have only been doing vision with Carol for one month, and my associate Dr. Montenare has been doing a marvelous job in helping Carol understand what her eyes are doing.  Carol had no idea that when she was stressed, her eso posture intensified.  She learned this feedback concept through doing peripheral awareness activities, Brock String, and most recently with large angle distance fusion emphasizing divergence in balance with convergence. As I was doing Carol’s progress evaluation this afternoon, she remakred how things were goings so well that she is now resuming driving locally, and can do so without the need for prism.  She can only do this briefly, and knows she has a long way to go, but she described it as having less fear when driving.  When I asked her why that was she remarked that she now realized she had control over when her left eye was turning inward, and had to get herself in the position of looking in a softer and more relaxed way, instead of trying harder.  I told her that was great, and we walked across the hallway into my consulting room to do a quick video to share her success.

12 thoughts on “Ophthalmology Referral for Vision Therapy

  1. I’m confused about the reply above that VT doesn’t work but that then he will share. I was just about to give abundant thanks for the hope you provide to people with vision issues, and the incredible ongoing sharing and research you do!

  2. I will be waiting to hear any comments the referring OMD gives when she tells him how much VT helped her! Hopefully he, too, will share…

  3. Good example of stress induced esotropia. I unfortunately have pts who drive with double vision and don’t think it is a big deal.
    Thanks for sharing this case.

  4. I always try to share with my patients, and their families, that awareness is the first step, understanding what is happening with the visual system and why, and then the work begins to learn how to control what is happening. As a therapist it is amazing to join people on this discovery, and so rewarding. Thank you for sharing and continued success!!

  5. More of these success stories of interdisciplinary cooperation need to be published in Ophthalmological journals. More patients would benefit.

    Secondly, our contact lens colleagues need to be informed of the dangers of prescribing and fitting mon-vision.

  6. Thank you, Dr. Press, for sharing this article. It actually hit home and made sense to me on a personal scale, as I have a similar history as Carol. It’s also wonderful to hear that an Ophthalmology referral brought Carol to you!

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