Thank you to COVD for this piece.
Difficulties while reading, working, and learning to play the cello caused this adult patient to seek a comprehensive vision exam with a developmental optometrist found with COVD’s Locate a Doctor tool. After a diagnosis of convergence insufficiency, he was prescribed glasses with prisms and a course of vision therapy. Follow his journey below as he retrains his brain and eyes to work together.
Things are really starting to happen for my vision! It’s so incredible but it also makes so much sense that such individually-tailored and directed exercises would start to really make an impact.
I can now control my eyes enough to read one word at a time and keep moving in a left-to-right direction, which was really challenging when I had no idea I was skipping and re-reading and jumping all over the place. No wonder I have to read things over… I guess I just learned to go fast enough that it made up for it. Fast but sloppy!
This week we started to work on my eccentric fixation (not looking at things with the center of my vision) and it explained even more of the visual symptoms I experience. This was the most validating thing we did so far and it really reassured me that I’m not making this all up! I’m so glad I spoke up and tried to explain how things look so my optometrist and vision therapist team would know what to test.
Many mysteries were solved when I was asked to navigate mazes on the Macular Integrity Tester (which my ingenuitive vision therapist made herself before they were commercially available! I’m so impressed!) Covering one eye, I had to move the “brush” (a sort of “x marks the spot” of the center of my visual field) through the maze. I was surprised to find that my right and left eyes acted totally differently and correlated so exactly with what I experience.
My right eye was first and it was relatively easy to navigate the maze. After I stopped hitting dead ends and finished, my vision therapist asked me how it had felt to go in the different directions. Left was the easiest and this correlated to moving from the end of one line of text to the start of the next one, which I confirmed is not difficult for me, so it makes sense that the necessary skill is easier to do.
The left eye was even more revealing. While it had been easy to keep the brush in the center of the maze path for my right eye, I could hardly keep it off the upper and right boundaries for the left one. This made so much sense because when we discovered my eccentric fixation, I had needed to look down and left of a target to aim the brush at it. It was also very hard to move downward and I was completely unable to even keep my awareness of the brush for the bottom part of the maze. Since we hold what we’re reading lower than our faces, this trouble lower down relates to my overall reading difficulty.
So this is what the mazes revealed: my right, weaker eye, had an easier time moving because its fixation isn’t as far away from the center of my vision. While my left eye is dominant and stronger, it must have started fixating eccentrically before the right eye started being turned off. Eccentric fixation was my brain’s first attempt to fix the double vision I experienced as a child, and because it would have been even more extreme due to my convergence insufficiency, my brain then learned to turn off my right eye for close work. What I ended up with is one eye that’s strong at focusing but off-center, and one eye that’s weaker at focusing and gets turned off close up. No wonder reading feels weird!
Today was the first day we started working on binocularity, meaning my eyes working together, now that my right eye was starting to get more caught up with my left. We did an activity called Squichels which is really fun to say but less fun to do–what a weird experience! I put on these bizarre glasses with giant prisms on them that forced apart what my two eyes were seeing. It was really disorienting and I definitely had a few moments of feeling seasick.
Wearing these glasses, I was asked questions about things on the table in front of me. How many did I see? Which one was higher or lower? Can I reach out and touch the doubled object? It was fascinating, disorienting, and mysterious, and I’m definitely excited to see how this new part of my therapy will play out!
Could you or your child be struggling with a vision condition like this VT patient? Locate a Doctor in your area and schedule a comprehensive vision exam today to find out during this month’s Vision & Learning Month!