Archive for the ‘strabismus’ Category

Vision Update


DS2 had his vision therapy appointment today.  She said that his tracking has improved as I’d observed but it seems there is still a slight favor for the left eye.  We are going to move forward with surgery.  It is scheduled for March.  Until then, we are going to keep his glasses on during the waking hours and patch 1-2 hours each evening.  We are increasing the glasses use so that he can focus at a reasonable distance to work on teaming his eyes throughout the day and increase my opportunities to do vision exercises with him.

In other news, DS2 is sitting up without support.  Much like his brother when he started sitting up but a few months later.  He will stay sitting up for 10-20 minutes then falls to the side or back.  I keep a Boppy around him for safe falls.



The little man got his glasses for vision therapy and he doesn’t mind them too much. Just pulled them off once but they are a rubber like material so not a real big deal. Been working on his eye exercises throughout the day. Hope I can get in a good reutine with it. Isn’t he cute?

Vision Therapy


We ended up seeing the vision therapist on Tuesday when she had a last minute opening.  She convinced us to do some therapy with her before and after strabismus surgery to get a better chance of the surgery working the first time.  She prescribed glasses and gave us several assignments to work on daily with the eye patch until we get the glasses and then with the glasses once we get them. 

Here is a simplified summary of our assignments in the pursuit of helping his eyes team together and help his overall development:
1.      Move an object at his centration point (the point at which his eyes work together which will be moved out to 12″ with glasses as its only about 4″ without) in a figure eight for him to follow.
2.      Move objects in the z-axis at his centration point for him to follow.
3.      Watching gingham pattern cloth held at centration point.
4.      Tummy time 
5.   Work on rolling back to front and front to back.
6.      Support laying on stomach on ball to pick toy up and then release.

I may even integrate these suggestions I found online too:
Visual Toys

We will do this for a month once the glasses show up and then back to her to see how it is going.  Unfortunately, the glasses are harder to get then I expected.  We will be getting the Meriflex baby glasses that are made from soft plastic and considered highly durable for babies/toddlers.  There are so few baby glasses and only a handful of local places have them and at a highly inflated rate.  I also looked into ordering online but after visiting a couple optometrists, realized it is just too hard to fit babies to be able to order sight unseen.  Even ordering locally, my optometrist had the demo kit but still has to order the pair we request so I don’t see us getting them before Christmas.  This also means that we will very likely delay the surgery.

Eye Surgery


We saw the Ophthalmologist this week for DS2.  Apparently patching 1-2 hours per day, even though I remembered only half the time, payed off for the babies strabismus.  The Ophthalmologist didn’t see the left eye start to dominate as before and we are at a steady 40 prism diopters.  He recommended strabismus eye surgery and we are now scheduled for surgery at the end of next month.  I’m not looking forward to it but the research supports the benefit for surgery for such a large alignment deviation and the earlier the better.

In the mean time, I’ve contacted two behavioral Optometrists.  One was a little too non-conventional for me and seemed to not feel surgery is ever warranted but the research I’ve found, even from The College of Optometrists for Visual Development, says it sometimes is and therapy can’t correct alignments greater then 20 prism diopters at best.  The second seems more up my ally.  She has years of experience and teaching credentials.   She is also not anti-surgery.  I was disappointed, however, that she didn’t have any names of Ophthalmologist that are supportive of vision therapy.  Our Ophthalmologist is great in many ways but is not at all supportive of vision therapy.  Apparently Ophthalmologists and Optometrists don’t generally get along anyway.  I believe that vision therapy can help post op to prevent the eyes from going crossed again which is a risk for DS 2 especially with his brain abnormalities.  I’m still debating if our first visit with the Optometrist will be before or after surgery as she doesn’t take insurance.



DS2 had his MRI Friday.  It was a little scary for mommy as he had to be sedated since the scan takes 45 minutes to an hour and requires you to be completely still.  It was a really long hour for me but once it was all over baby was fine.  He continued to nap for about 30 minutes then woke up slowly.  It took a few minutes to get proper sucking down then he was able to nurse.  After nursing for about 20 minutes he was smiling and looking around.  We were at the hospital for about 3.5 hours total.  He napped a little on the way home and slept well that night.  I was very happy with the care and patience at National Children’s Hospital as usual.

Yesterday, Tuesday, we got the MRI results.  No surprising findings.  No tumor and it isn’t Joubert’s Syndrome as suspected.  His brain stem is smaller then it should be (this area controls vision) and another area is smaller then it should be (controls vision, motor skills and speech).  The nerves to the eyes also appear thinner then they should be.  So, his symptoms of optical apraxia and crossed eyes are not surprising nor is his low lone and physical delays.

This does complicate the opthamologists recommendation to do stabismus surgery to straighten his eyes.  Given the damage in the brain, there is a lower chance of the surgery being successful.  The opto-neurologist said it is worth giving it a try and soon but I’m not convinced.  I’ve got to do some more research and sole searching.

All and all, I feel I’m taking this well.  Not sure what to do next.  The opto-neurologist said there is nothing more  we need to do right now but Occupational and Physical Therapy weekly as we are doing and he’ll probably need speech therapy when he is older.  He also referred us to a geneticist to see if we can identify a genetic link.  He says the abnormality does not look like something that I did wrong or brain damage but rather something that occurred early in the development (first trimester).  For now, I like not having a label, as the opto-neurologist said, the brain is plastic and can adapt/change a lot especially at just 8 months old so we just have to keep working on the symptoms and not “type cast” his future potential.