A Perspective on Dropping the Ball


This afternoon an astute  mother who is a very reliable historian brought her 7 year-old daughter in to consult with me.  I had prescribed yoked prism for her younger son who has special needs, and has double dissociated intermittent hypertropia.  I had also seen an older  brother for whom I prescribed an add, but no prism.  Her daughter has been exhibiting a strong aversion to reading, despite being very  bright.  My evaluation showed that she had a “can’t miss” convergence insufficiency, with 1^ XP at distance, 10^ XP at near, an NPC of 8″/14″, and awarenesses of intermittent double vision when reading.  I reviewed the findings with mother, demonstrating the C.I., the effect of the Rx as her daughter read, and mom told me that it all made perfect sense.

Interestingly, her mother related that she had taken her daughter to be examined by a pediatric ophthalmologist two weeks ago.  After doing a stereo test which her daughter passed, Dr. X said: “If she can see the pictures popping out, is shows that she doesn’t need prism”.  Hmm …

I save dilation or cycloplegia for last, so before I put the drops in I casually mentioned to mother that Dr. X no doubt put drops in her daughter’s eyes last time but she said: “No, actually he said that since there was nothing wrong, there was no need to put drops in”.  Hmm … interesting, again.

Earlier in my career this would have troubled me, but at this stage of the game my heart simply goes out to the children whose visual needs are left unaddressed.  Thankfully our patient population is comprised of astute parents.

Screen Shot 2020-07-16 at 3.55.54 PM

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