Thursday, August 7, 2014

Do You See What I See?

We went to the developmental ophthalmologist for the first time today. For those like me that didn't know the difference between a developmental ophthalmologist and a regular ophthalmologist, a developmental ophthalmologist is an eye doctor who has completed two to three years of post-graduate training and is credentialed as a Fellow in the College of Optometrists in Vision Development, or F.C.O.V.D.  

We made this appointment at the recommendation of his occupational therapist who mentioned that she had noted he has problems with eye tracking and with shifting vision from near to far.  Little Man already sees a regular ophthalmologist and wears glasses.  Since we (and Little Man's teachers) have seen the same problems we've mentioned his issues there but the Dr just assures us his proscription is correct, so we thought it would be a good idea to go ahead and get the developmental screening done.  He clearly has more going on than just visual acuity problems.

As expected Little Man showed signs of learning related vision problems in his screening.  If anyone is wondering if someone they know may be having problems, the symptoms of learning related vision problems include:

  • Headaches while reading or writing
  • Blurry vision when reading
  • Difficulty smoothly reading across a line
  • Skipping words or entire lines when reading
  • Difficulty copying from the blackboard
  • Avoiding reading and writing
  • Poor reading comprehension
  • Short attention span
  • Moving one’s head excessively when reading
  • Poor handwriting
  • Burning, itching, or watery eyes
  • Bumping into things
  • Holding books too close or too far
  • Squinting
  • Difficulty recognizing faces

Little Man was diagnosed with Ocular Motility Dysfunction and Accommodative and Vergence Dysfunction, specifically. This is of course in addition to his overall sensory integration issues with coordinating visual input with spatial, auditory, motor, or tactile stimuli.  I can’t say we are surprised.  Issues with the formation of the visual system (and the ears although that is a whole other series of posts) is common with FASD.  Up to 90% of children with prenatal alcohol exposure show ocular manifestations (Strömland, 1985, 1987)

So now we are trying to find some way to fit regular follow up with another specialist and weekly vision therapy into a schedule already crammed with OT, PT, Speech Therapy and too many specialists to remember without “the list.”   I am never ever unwilling to do anything Little Man needs. I sure do wish there were more hours in a day though. Sigh.


  1. Very interesting. I've noticed these symptoms in one of my children. The other has 1 pupil 2 mm larger than the other. I wonder if that's her FAS or from trauma suffered as an infant? The pediatric opthamologist said both eyes are 'normal' but I still wonder.

  2. I was surprised to find how very common eye problems were with prenatal alcohol exposure (PAE) when I started researching. I know that effects can show up in any system of the body but my emphasis has always been on the brain so the 90% number blew me away. I'd suggest looking specifically for a developmental ophthalmologist / optometrist. With PAE involved the structure of the eye can be perfectly healthy and "normal" but you may still have problems with the connection of the eye to the brain, of the brain to the muscles controlling the eyes, etc. Vision therapy cannot reverse alcohol's effects on the brain of course, but just like occupational or physical therapy may lead to some improvements in gross and fine motor control vision therapy may help with some issues of eye tracking, control, focusing etc. We have also gotten some good advice on accommodations to make his issues less troublesome for him.