Vision. For Life.

Eitan’s Case Study and a Testimonial. 

I’d like to share this case with you because it really is typical of so many of the outcomes that we achieve with our patients, of all ages, here at LedermanVision. I don’t often receive video testimonials, and certainly not all patients feel comfortable in front of a camera. I’m therefore happy to share this case study, and testimonial with you. 

Obviously, not all issues can be solved by improving visual input alone. Situations can be complicated, which is why a team effort enabling the child to benefit from everyone’s expertise at the right time, will often produce the best outcome for the child/adult. 

Eitan, who you’ll see in the video, came for a routine examination in August 2020.  However, his story with me began in April 2018 when he was referred to me by his occupational therapist, and I had recommended bifocal reading glasses, and optometric vision therapy. When he told me in August 2020 that he had just read all the Harry Potter books, I was delighted. I could see from his history that in the past he’d “hated reading”. I therefore asked him if he’d be willing to share his reflections about how the treatment he’d received at LedermanVision changed things for him, so that perhaps he could help other people think about considering reduced visual efficiency as a cause of their performance issues. This is what he sent me.

https://youtu.be/eA8VUgMrTwQ  

https://youtu.be/ZhTxE6ZffkY  (with Hebrew subtitles)

The Important Points. 

If you listen carefully you will understand quite how many areas of Eitan’s life were being affected by visual issues, and how things changed because of his improved visual function. When I look at the notes I took at the initial intake, Eitan complained of disturbing intermittent double vision and tearing. He was on Ritalin which he said had been helpful for reading. 

These are Eitan’s results on the Developmental Eye Movement Test. (the red line indicates Eitan’s performance).

His vertical score was on the 47th percentile, whereas the horizontal score which reflects his performance when moving his eyes form word to word, and line to line, was on the 17th percentile. The horizontal/vertical ratio was on the 7th percentile. This reflects h the great effort Eitan was making in order to move his eyes together across the page, and how his visual system was interfering with his ability to reach his learning potential. 

These were the scores of his fusional reserves. There are four measurements here, and Eitan’s score in each of them is on the left. The minimum goals to be achieved are on the graphs. None of Eitan’s scores (blue) are in the green. 

Eitan also shared a small tendency for his eyes to cross when reading. This is why I prescribed reading glasses. 

In addition to his glasses, I recommended 20weeks of therapy.

Following therapy there were many clinically measurable differences including in his performance on the Developmental Eye Movement Test. As you can see, his horizontal score had improved significantly and was now on the 53rd percentile. The horizontal/ vertical ratio was now on the 60th percentile

His fusional reserves were now much improved. All scores are now in the green zone. 

This is the list of how Eitan’s visual issues were affecting him in his life. 

  1. a) He suffered from a lot of headaches
  2. b) He experienced intermittent double vision when reading
  3. c) he would tear when reading
  4. d) he could not follow the notes on a musical score 
  5. e) he had disorganized hand-writing (not on the lines, inconsistent letter size, poor spacing)
  6. f) he was unable to catch hit a ball
  7. g) he had symptoms indistinguishable from ADHD, and was being medicated with Ritalin. 

Motor Response to Visual Input

Eitan, essentially, was living with an inefficient and disorganized visual system.  When you’re living with a disorganized visual system, your inner world will be disorganized as well. Things aren’t quite where, or how, they appear to be. Our visual system should be able to compute everything to do with “where and when”.  Eitan was unable to hit the ball because he was unable to keep his two eyes on the ball.  And so, the brain filled in the picture with a location, but it wasn’t the correct location. He wouldn’t be able to experience where the ball was in its journey, or when it was going to arrive at his bat. Optometric vision therapy helped Eitan to learn to point his eyes together and maintain that fixation in a dynamic situation, and he became able to compute where the ball was in space, and catch / hit it. Eitan’s case also reminds us that it’s not only about reading. Considering vision-related learning problems only, may limit a person’s ability to benefit from all that development optometry has to offer.  This will result in limited outcomes for the patient. We need to be able to scan shelves, and feel comfortable finding our friends in crowded places (hopefully soon!), and of course have fun catching balls! We also need to understand everything happening on the road when we are driving. 

Reading words/music, Writing, Comprehending, and Learning

When you’re working so hard to hold your eyes together when looking at a page, as evidenced by Eitan’s headaches and tearing, it’s hard to have enough resources left to process all the information that you’re gathering.  Consequently, the spaces between the words don’t show up in your consciousness. Or you can’t notice that you’re writing letters of different sizes, that are not on the lines. It’s also hard to understand where the note is on the sheet of music so that your brain can prepare the next saccade accurately. 

Attention

When you’re not focused visually, you cannot be focused mentally. This can lead to behavioral patterns that are indistinguishable from those of ADHD. I spoke recently with a family Doctor in Jerusalem who just finished a course to improve his diagnostic skills regarding ADHD. He reminded me that there is still no single test for making the diagnosis of ADHD, and that is only ever based on behaviors, signs and symptoms. So, establishing that a person can indeed meet the visual demands of the tasks that he/she is trying to engage in is essential. However, as you see in this case, you need the appropriate specialist. 

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Author

Robert Lederman
FCOVD

A passionate optometrist with over 35 years of experience, transforming lives through vision.

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