Ophthalmology Referral for Vision Therapy – Part 2


Part 1, in which we discussed Carol’s decompensated esotropia at distance hastened by a failed attempt at monovision contact lens correction, and subsequent need to abandon driving, generated alot of positive feedback.  Obviously it isn’t (yet) commonplace for ophthalmologists to refer patients to optometrists for vision therapy, and a number of colleagues contacted me by email asking more about the referring M.D.  As coincidence would have it, the patient responsible for establishing that connection was in our office yesterday afternoon for a progress evaluation. L, using just her first initial to preserve confidentiality, is a 67 year-old female with a Ph.D. in Environmental Medicine who is married to an orthopedic surgeon.  At age 4 she was diagnosed as having strabismus of the left eye, which was not treated throughout her childhood.  She recalls in high school being complimented by her lab instructor in biology because she was able to view slides through the monocular scope with her right eye and simultaneously draw what she saw with her left eye.  By the time she reached her mid 20s, doing graduate work in Pittsburgh, L felt that she had to do something about her drifting left eye, and she had multple sessions with an orthoptist that seemed to help her develop better control. Orthoptist In her 40s L realized her left eye was driftng outward again.  She had settled in New Jersey and did a round of orthoptics in an ophthalmologist’s office.  Two years ago she went to a different ophthalmologist because she felt that she was drifting again.  This time the doctor did no tests for binocular vision, despite her history, and she was told that she needed cataract surgery on the eye.  Trusting the doctor’s opinon, even though she felt that her vision in the left eye was the same as it had always been, L underwent cataract surgery.  Unfortunately she suffered significant anterior segment complications as a result of the procedure, the details of which I’ll spare you but made her miserable. When her left eye finally healed, L went to yet another ophthalmologist who advised yet another round of orthoptics.  She used many of the same free space fusion procedures that she had undertaken several times before, for example the barrel card technique. This time however L’s binocular vision was so decompensated that she needed prism at near just to fuse the targets.  She was unable to wear her progressive addition lens prescription, and had all but abandoned reading, wihch was her passion.  L was, in her own words “upset and bitter” over how she underwent cataract surgery prematurely in the left eye without any consideration as to how her convergence might be affected.  A casual conversation at the optical place where L filled her prism Rx acquainted her with the option of optometric vision therapy.  She asked her ophthalmologist what he thought and he replied: “I suppose you have nothing to lose at this point”. When I first examined L on September 16, 2014, she had a whoppiing convegence insufficiency measuring 3^ exophoria at distance and 24^ IXT OS at near … Long story … L began office based optometric vision therapy and within a few months she was back to wearing her progressive lenses comfortably without the need for prism.  Our office staff  commented yesterday, at her final progress evaluation how much L’s personality had changed.  She now came in with a smile, no longer bitter at her fate.  L is not, by nature, an effusive woman but she related that she went back to her ophthalmologist with a fistful of our business cards after her first month with us and said: “You have to give your patients the option of optometric vision therapy.”  So now you know the rest of the story of how Carol got to us .

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