The Case of the Type A Attorney

Ted first came to see me 15 years ago on referral from his primary care optometrist.  He was miserable because as an attorney his primary visual demand was reading and he could barely function.  He had significant esophoria and …


Ted Long Story Short

… after vision therapy was able to function reasonably well.  Evidently about  5 years after that (10 years ago) he was seeing an ophthalmologist, who he met socially, who convinced him that monovision contacts was the way to go with a plus lens over the left eye for near and the right eye for distance. And he did, and was happy as a clam, describing it in his written narrative as the first time in his life that he was able to read all day without headaches  …


… until last year, when he began to unravel.  He still felt he could drive fine and watch TV okay, but reading again had become nearly impossible.  After fiddling with a contact lens correction for his right eye and upping the plus power (and cylinder) for his left eye, the doctor tried spex with base out prism.  All to no avail.  Although he was 66 years old he wasn’t ready to give up practice, and at the office he found himself so miserable that he wore a patch over his right eye which allowed him to read in spurts.

Given his personality and the fact that monovision had made him so incomparably happy for 10 years, I knew that Ted would not be a good candidate for vision therapy.  Sometimes it’s better to find a way to restore visual happiness than to shoe-horn a patient into binocular nirvana.  Ted’s ophthalmologist told him that his right eye had a mild cataract (lenticular degeneration) but there was no point in considering surgery.

What do you think is happening with Ted?

4 thoughts on “The Case of the Type A Attorney

  1. He no longer has the option to be a one eye for distance and other eye for near patient. He must regain his binocularity to earn a living and to participate in the rest of his life ‘s activities. He has a long way t to go. It’s worth it to retrain him.

  2. Sure he does, Michael. I think you missed my point. He was a happily adapted monovision patient and only lost it because his distance eye became blurred due to lens degeneration, Out with the old, and in with the new, and his effective monovision will be restored. Therapy didn’t work as well as monovision when he was 15 years younger; it isn’t going to be any more successful now. I used this to illustrate that VT isn’t always the answer for all cases.

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