Vision Therapy Across The Globe
A few years ago I had the great pleasure of consulting with Jolene, a mother who was interested in vision therapy for her two children and herself. Jolene lives in Malaysia and had become increasingly frustrated with the doctors and orthoptists she had access to. Her five year-old son, Caleb had eye muscle surgery at age two for an amblyopic eye that turned in. Caleb was not showing sustainable improvement after his surgery and the meager therapy that was offered - mostly just patching. Jolene refused to sit back and accept that it couldn’t get any better and began looking for answers. Eventually we were introduced to each other. I am not, and never have been, in Malaysia, but I could not resist the temptation to help Jolene and her children in any way I could.
We met via email. Jolene’s grasp of the visual process was astounding. I imagine this was due in some part to her having read Sue Barry’s excellent book - Fixing My Gaze: A Scientific Journey into Seeing in Three Dimensions. Jolene's dedication to getting the best for her children was also impressive and perhaps enhanced by the fact that she also had an eye teaming problem. Jolene had infantile esotropia (one eye turning in) and her first eye muscle surgery at age six months and a second one six months later. By the time of her third surgery as an adult (in her early 30s) in 2009, she was an exotrope (one eye turning out). In Jolene’s words, “I had my second strabismus surgery with adjustable sutures only on my left eye. I checked the mirror during the procedure and my eyes looked nice and straight. Unfortunately, the next morning, I woke up at home to find myself an esotrope!”
Jolene was having no luck getting the doctors and orthoptists to think outside their comfortable box. She tried to share her research with the orthoptist, but was rebuffed. She wanted so much more for her children, both of whom had already had strabismus surgery. Caleb’s eyes were already losing whatever fragile alignment the surgery had provided. This is because there was no therapy program designed to keep the eyes straight by getting the brain to understand how to work with the surgically altered eye alignment.
Jolene had already read my article on binasal occlusion and tried this on herself and her children with some positive effects. She had also devised a fairly decent vision therapy program with equipment she had accumulated or made from scratch. She was clearly doing more for her children’s visual development than all the eye care practitioners to whom she had access. Jolene was looking for guidance and support to supplement her homemade vision therapy program. I was happy to help if possible.
Via email Jolene described what she was doing. Some samples follow:
From March 18, 2010
From my limited experience, when we first began patching his right eye we saw immediate improvement within 2-3 months. At this point, the Eye Surgeon, would then say we could stop patching. However, 3-6 months down the road, his left eye would be amblyopic again. Hence, patching would begin for the next 3-6 months daily. And the same cycle begins. We have started and stopped so many times over the past 3 years.
Based on Susan Barry's book I feel that I really need to try, (even without anyone here to support us), I stopped using the black eye patch on his good eye because patching seemed to break down whatever binocular function that was forming and his esotropia would become so much more prominent within a few days. I began rubbing a piece of bar soap all over his right lens in order to drastically limit the clarity, without shutting off 100% of visual input.
But I realise that sight acuity isn't everything, and unless his amblyopic eye is comfortable with pursuits, saccades, near/far focus, peripheral vision, etc, this problem will continue to recur.
Jolene needed someone to support the excellent work she was already doing. Our email exchanges were always stimulating and enjoyable and it seemed that my input was helpful. I mainly served as a sounding board for Jolene; I was able to fill in some gaps in her knowledge and provide some tips that are only likely to come from someone with experience in providing vision therapy. I would have preferred that Jolene and her children work with a local behavioral optometrist, but there wasn’t one at the time. I remained confident, over the year we worked together, that Jolene’s understanding of the visual process and how to use that to her advantage was better than anyone in Malaysia at the time. I turned out to be right and our work together helped Jolene and her two children improve.
Finally there is a behavioral optometrist that Jolene and her children can work with. I couldn’t be happier that Dr. Stanley Tien is now providing thorough visual developmental evaluations and vision therapy in Malaysia. Stanley is a wonderful man and is clearly doing excellent work. Please take a few minutes to enjoy this video where Jolene and Caleb describe their experiences.