Allie had her eye appointment this morning to check visual acuity with a pediatric optometrist/vision therapy specialist. I wanted someone who specialized in vision therapy with kids to double-check the diagnosis and treatment plan from the Kaiser pediatric ophthalmologist (Dr. S)’s exam last month.

Allie was great; very cooperative (albeit fidgety) and because she was able to identify colors and shapes, Dr. T was able to get a read on the eye chart, altho she didn’t tell us what the exact numbers were. So instead of letters, Allie was making distinctions between square, a house-like pentagon, circle, and something that has the top of a heart but also has the bottom sharply pointed in, sort of like an apple. Allie alternated between calling that shape a “heart” and a “strawberry.”

The diagnosis was pretty much the same. Dr. T found Allie to be a bit far-sighted, and as for the “wandering eye,” said it was intermittent and alternating, meaning Allie sometimes favors the left eye and lets the right eye turn out, and sometimes focuses with the right eye and the left eye then turns out. That, at least, means the brain is receiving signals from both eyes and the neural pathway is there. Dr. T said the brain is just somehow unaware, when Allie’s looking out far or is relaxed and spaced out, that the eyes are turned away from a focal point, but once brought to the brain’s attention, such as by asking Allie to look at something in closer range, Allie is able to immediately bring the eyes back in and focus properly. So the auto-pilot of keeping the eyes forward-pointing is what’s slightly off. Her brain’s supposed to regulate the eyes without her need to consciously do it, and her brain doesn’t do it all the time. Like Dr. S, Dr. T thinks this isn’t an urgent situation and surgery is a distant option.

Dr. T. asked what Dr. S’s treatment plan was, and I said he wanted her to be patched 4 hours a day, alternating eyes between the days. Dr. T said that this is a good plan, and whatever amount of time Allie would allow for this patching will be good, even if it’s 20 minutes a day to begin with. She suggested that since Allie so wants to watch and play with the iPad, to tell her iPad time is okay as long as she’s wearing the patch. I asked wouldn’t this patching split up the cooperative use of the eyes that we want to keep and encourage for proper binocular vision? She said there are multiple theories on this, but that if we don’t want to do patching at this point (I really, really don’t), it’s okay and we can try vision therapy first. She said she’s not promising that SOME patching won’t come later. This is great because Dr. S not only doesn’t do vision therapy for kids this young, but he also said he didn’t think vision therapy would help Allie’s condition. Mr. W and I think it will because we’ve recently increased Allie’s permitted video/iPad time, seeing that Allie’s eyes are always focused and cooperating when she’s watching a video on or playing with the iPad, since she’s so interested in it, and in a week or so, she’s able to bring her focus in much more easily and quickly when she’s having a turn-out moment.

So next step: we’ll make an appointment with the vision therapist at this office to evaluate whether Allie is able to do in-office vision therapy sessions. She needs to be able to follow directions and do what’s needed for 45 minutes, and to give proper feedback so they know what she’s seeing. Dr. T thinks Allie’s sort of borderline in being able to do this; she was impressed that for a kid not even 2, Allie follow directions well and is able to verbalize what shapes, colors and pictures she sees, and was tolerant at wearing glasses that covered each eye in turn and in looking through that big contraption that goes over her face to check her vision.
If Allie is able to do in-office vision therapy, she’ll likely start once a week with “homework” daily that we’ll help her on, such as activities and special movies wearing special glasses. If not, we’ll still get “homework” in vision therapy to start, most likely a red/blue video(s) that she’ll watch wearing red/blue glasses, so that if her eyes diverge during the video, the side of the video with the eye she’s not favoring will turn black, and it’ll give her brain a kick to say, “Oh hey, something’s wrong,” and train her awareness to bring the eye back in.

Because we have Kaiser and it’s not a PPO, this office visit is completely out-of-pocket and cost me $185 today. Each subsequent vision therapy appointment is $100 a pop, which is insanely expensive when you consider that if we go the eyepatch route, it’s less than $10 for a box of adhesive eyepatches, but I’ve gotten so much feedback from adults who were patched as kids who say it did nothing for them except make them miserable, that I’m willing to throw money at a different Plan A first. That’s what rainy day savings are for, right?