Hello! I’m Amber. Ann recently posted about Stella, my little “fashion visionary.” She honestly does love wearing that “pirate girl” onesie! Stella very recently turned two and, in addition to wearing glasses and patching three hours a day, is two weeks into vision therapy. I’d love to share our vision therapy stories and hear about your experiences, especially with vision therapy for very young kids as it seems to present unique challenges.
First, let me explain how our path led to vision therapy. Treatment for her vision issues (first, accommodative esotropia and now ambylopia) began in April in the ER at Seattle Children’s Hospital. She’d been sick with a bad cold and had lost about a pound, and that morning I thought she’d bumped her head (saw it out of the corner of my eye–I wasn’t sure about anything but the screaming). That’s when both of her eyes suddenly started crossing–severely. Her pediatrician was visibly alarmed and sent us to the ER where they ruled out serious lie-threatening problems via head CT scan and tentatively diagnosed her with “convergence spasms.” A couple weeks later, we were routed to one of Children’s Hospital’s ophthalmologists. We now realize that the illness and stress must be what brought out Stella’s latent or, at the very least, hard to detect intermittent esotropia. I wish the ER had been aware that this was actually a rather common presentation, so Stella could’ve avoided all that radiation. Hindsight is 20/20. Unlike Stella’s left eye. Ahem.
After a very thorough exam, the ophthalmologist prescribed glasses, which have helped a lot in keeping her eyes straight. Then, at the follow-up appointment, they told us to start patching as visual acuity was decreasing in her weaker eye (her left eye has a stronger prescription which, from what I gather, means she has anisometropia). They said she may need to patch for years, but never mentioned vision therapy, I suppose because most ophthalmologists not only don’t offer it but aren’t very familiar with or approving of it. After reading Fixing My Gaze, I became dissatisfied with this approach for Stella and was excited to explore the possibility of vision therapy. Our second opinion came from a developmental optometrist who told me that Stella was too young for vision therapy. Luckily, we sought out a third opinion from a developmental optometrist who, among other seemingly innovative suggestions that differed from what we’d heard elsewhere, said Stella could begin vision therapy at this age! We now go every Wednesday morning to play “eye games.” The vision therapy guidelines they gave us initially say that most courses of vision therapy span nine to 12 months. Our journey is just beginning.
One of the concerns–actually, it’s more of a mental conflict–I’ve had about vision therapy is in regards to Stella’s age. Susan Barry, in Fixing My Gaze, and other experts urge us parents of children with vision issues to begin treatment (be it patching, glasses and/or vision therapy) as early as possible. Yet, not only was Stella denied vision therapy at one developmental optometrist’s office due to her age, but I’ve been hard-pressed to find specific information or success stories about vision therapy at such an early age. All the wonderful, encouraging outcomes I read about seem to involve children between the ages of about five and 10 or so. The exercises are no doubt easier to execute at that age, including the seemingly more fancy, advanced activities that require a kind of sustained focus that Stella just can’t generate at this point. But the younger you are, the more elastic your brain, so not pursuing vision therapy early on feels like a missed opportunity.
To be honest, while Stella’s current, wonderful doctor always saw vision therapy as a part of Stella’s treatment plan (probably to begin after a couple more months of patching), I nudged her toward allowing Stella to start sooner. I’ve been torn between feeling excited about doing vision therapy right as she turns two, and nervous about whether it will be a waste of money, though the latter concern is being assuaged as we go. (Vision therapy is decidedly and painfully not covered by our insurance. It costs $125 a week, and we had to pay a one-time $50 fee for supplies that we’ll be borrowing for home-based vision therapy. Anyone need a good freelance copywriter? I sure could use the income. Yikes!)
She does well with the weekly in-office exercises, and seems excited upon arrival. They make the sessions fun and age-appropriate, so there’s lots of novelty and variety. At this early stage, all the activities are monocular so as to help the ambylopic eye get back up to speed (we keep the patch on during our visits), and then we’ll move to binocular exercises to get the eyes to work together. Last week, she was clapping bubbles, catching balloons, and riding a Sit N’ Spin–after three quick spins, a number puzzle piece was immediately held way off to the side of her head, so she had to turn to focus on it, say which number it was, then work to place the piece in the puzzle, all while her eyes recovered from dizziness. By the time we got to number nine, she was pretty much done. Today, she put little quills into tiny holes in the back of an adorable toy porcupine (of course it’s a toy–though the real thing would’ve been a total challenge, visually and otherwise). She also went fishing, which was a hit. This game required her to scan the room to find/identify the octopus, shark or other specific animal amid the gray sea of the office’s carpeted floor, carefully lower the magnet dangling from her little fishing pole onto the magnet centered on the animal, then deposit it in the container held by the therapist.
I’ll admit that so far, it’s been hard to do the vision exercises at home. Sometimes, impossible to the point of my wanting a glass of wine at 3pm. Stella’s attention span and patience are not only low due to her age, but because the activities we’re supposed to do are uncomfortable for her. Of course, that’s the point–to challenge her eyes and make them work harder and in ways that are currently outside her left eye’s relatively narrow comfort zone. For instance, we were supposed to play catch with the balloon for a bit each day, as we did in the office. But after a few days, she simply refused to even look at the balloon , no matter how hard I tried to entice her. Sadly, I found myself on my hands and knees, begging and pleading for a good ten minutes, and near tears at one point, to no avail. Pathetic image, I know. Even chocolate chips, previously very compelling rewards, no longer held any sway. Today, Stella’s vision therapist, who’s been wonderful about answering my questions via email, explained that Stella’s resistance is normal. It takes a while for little ones to go get with the program, much like the period of adjustment and gradual acceptance of glasses and patching. By providing a variety of fun activities and not forcing things too much, I hope that eventually, we can make home vision therapy an enjoyable and regular part of each day. The therapist asserted that the benefit of doing vision therapy at this age is that they respond so quickly, and noted that it’s very exciting and gratifying to see their progress unfold.
There are other benefits of vision therapy that I hadn’t really thought about or anticipated. For a worrywart like me, it’s reassuring to have a knowledgeable person (the vision therapist) keeping tabs on how Stella’s eyes are doing and getting familiar her visual capabilities while watching them change and evolve. Especially in the face of widely conflicting opinions from doctors, I’d felt like it was all on my shoulders to monitor the situation and to make sure all was well. Now I feel that I can relax a bit. Vision therapy is also an opportunity to get answers to questions, and I take over-the-top advantage of that. At the same time, the vision therapist can point out when Stella is showing the true capabilities and impairments of her weak eye and it helps me more clearly understand how Stella sees the world and what needs to change. I’m likely to chalk up any fine-motor-skill deficiency to Stella’s young age, when may really have more to do with her vision. A couple of times today during her appointment today, Stella aimed to the side of her target and then adjusted to hit it correctly the next time. The more times she does that, the therapist explains, the better. I can’t put it in technical terms as this point, but each time she successfully corrects her weak eye’s misjudgment, it helps Stella’s brain and eyes figure out how to more accurately see the world and judge spatial relations.
Aside from making me less neurotic and way more patient (sigh, I’m working on it), here is the true goal of Stella’s vision therapy, as stated in an email I received from the vision therapist:
“This is a great opportunity for us to monitor and improve Stella’s vision before she encounters all the visual stress that school and daily life can bring. The things I mentioned (such as including movement breaks rather than allowing extended near work without a break) are good ways we can keep Stella’s visual stress low right now while we work to improve her vision. Starting VT [vision therapy] at such a young age allows us to prepare her vision and help her to become comfortable (and have stable vision) with different tasks–near, far, and everything in between.”
So, that’s our vision therapy experience so far. If anyone is interested, I’ll keep you posted on her vision therapy, and you can always read about what we’re up to, vision-wise and in general, at my blog at The Life and Times of Stella. It would also be great to hear about others’ experiences with vision therapy, at Stella’s or any age for that matter! Maybe we could help each other with tips and ideas for home vision therapy efforts that have worked (or not). Thank you, and may the force be with you.