What is a developmental optometrist? I had this very same question but with my experience in the medical field, more specifically pediatrics, emerging science shows that kids need their own doctors who specializes in their unique needs. As a former pediatric nurse, I would always cringe when people would term children as “little adults.” This is simply not so. They have a vast array of different disease processes and different etiologies than adults. A majority of their diagnoses stems from congenital defects or variations during development. Some of these variations in development can lead to lifelong problems that require treatment well into adulthood if not detected early. A developmental optometrist is an optometrist trained to treat individuals with developmental or functional vision related problems. Their training extends well beyond a regular optometrist who detects and treats eye disease, examines binocular vision and convergence, and uses refractory to prescribe corrective lenses.
I am telling you this because this is the type of doctor we were referred to. I was told that there would be two individual testing sessions, each several hours a piece. I was forewarned about the cost of the testing and initially I balked at it. After taking a deep breath, I quickly realized O is worth it. Literacy is worth the price.
We had to wait a month to get in for the initial testing. During that time frame, we continued with the child study evaluation for special education. O was approved and labeled with a specified learning disability. This means she doesn't have an organic cause to her learning difficulties (such as a medical diagnosis). They determined it's simply due to her IQ afer testing. In other words, they have determined after a test that she's not smart. I was able to finally breathe a sigh of relief that she qualified, but inside my head I had no clue what lay ahead. There were still a number of questions I had because I didn’t know what would happen after the vision testing.
That was of course until I was randomly taking care of a patient who I happened to overhear her talking to her son about his vision therapy. I immediately took that opportunity to get more information from a parent’s perspective. I listened to her explain her story and she started talking about 42 weeks of therapy. She raved about the doctor and how amazing he is at what he does. I was grateful to hear the doctor was highly recommended but I also started to get nervous because that simply couldn’t happen to our family. There was no way our busy lives could accommodate that kind of lifestyle. I found myself praying that our lives wouldn’t be affected in that way and thereapy would be different for OUR child.
We finally had our appointment and I was quite impressed by the specialist. There were photos of what seemed like hundreds of smiling kids wearing cap and gowns adorning his walls. I interpreted that as many children have graduated his program and are doing well. He quietly acknowledged me and went over to greet O where she was playing. She was in a corner playing with a dollhouse so he picked up a doll and played with her. We went back into his office and began to talk about O’s symptoms and her struggles with reading and writing. He conducted a battery of tests over several hours to evaluate convergence, accommodation, depth perception, visual acuity, and tracking, just to name a few. He used prisms and an archaic computer program to evaluate how O moves her eyes when she is reading and qualntatively indicates what she is actually seeing in her visual field. He explained every test in great detail so I would be informed. Hind-sight being 20/20 (pun intended) I wish I would’ve taken more thorough notes so I could explain in better detail what how he determined his diagnosis. I can affirm that he did this in a systematic, detail-oriented manner that was age appropriate for my then six-year old.
First, the good news. We have a solid diagnosis. Actually we have a few. O has a visual perceptual delay related to several disturbances in her visual field. Her first original diagnosis by her regular optometrist was confirmed, amblyopia. She also has problems relating to binocular dysfunction, saccades (tracking smoothly when reading word to word), depth perception, and accommodative dysfunctions to name a few. Well, no wonder why she can’t read. She doesn’t know what she’s reading.
Amblyopia is also known as lazy eye. Some people think that lazy eye is a simple drooping of the eye lid or a weakened eye. They are half right. Amblyopia can be severe and irreversible if not treated. In the simplest of terms of how it was explained to me, think of the eyes as siblings and the brain is the parent. The good eye is the more dominant bully eye always seeking attention from the mother. The bully eye never lets the less dominant, or lazy eye get any attention. The bully eye requires so much attention that the lazy eye simply gives up and no longer demands attention from the mom. After the lazy eye gives up, vision can be completely lost. It was determined O’s case of amblyopia was severe and was impacting all of the other deficits we discovered she had. Now this makes me wonder if her learning disability is in fact organic in nature because she is a smart kid.
Now the bad news, his next words came out his mouth impacted me as though I was handed down a jail sentence. She will require 42 weeks of therapy, at a cost that isn’t covered by private insurance. The cost is a hundred dollars a session once a week, but a discount is provided if you pay for the entire year up front. I was advised that conventional treatments for amblyopia in the "old days" providers would patch the good eye to force the bad eye to work. He told me that research has proven that patching the good is not permanent and it only temporarily reverses the problem.
At first I didn’t understand why it would take such a long time. I thought back to the pictures of the smiling kids wearing caps and gowns on his walls. Were they all success stories? Did everyone have to go through 42 weeks of therapy? What is it specifically about the number 42 anyways? Is it a magical number? Why does it take so long? Is this real medicine or is he simply trying to part me with my money? More importantly, why is this happening to O? How do we do this? These are questions that I would have to wait months to get answered.
I left the office feeling bewildered and overwhelmed.As I was checking out the office staff told me they would call me when the next appointment for testing would be available. I was then informed vision therapy would have to be the same day of the week, same time slot every week to accommodate the office schedule and provide continuity of care. It was as though the panic rose in my throat and wanted to start screaming, but I held it back. The only thing I could think of was, I am a nurse and my work schedule is so erratic, how in the world am I going to accomodate this requirement to help my daughter? My mind started reeling as though I was going to figure it out at that moment. That is when the secretary told me square in my face, “you can patch it, it’s better than doing nothing.” What was it the doctor just told me about patching? Was this good advice if I decide not to do this?
Oh boy, here we go…. If you know me you are probably stifling a laugh because I think mama bear just entered the room.