Should I fix my eyes?
March 21, 2017 12:15 AM   Subscribe

I have a diagnosed vision problem and a diagnosed learning disability. The symptoms for both are very similar. The optometrist says vision therapy may improve my life, but it is very expensive and I'm worried about spending a lot of money only to discover that the real issue was always just the learning disability. Can anyone share their experience with binocular vision therapy?

I get my eyes checked at the optometry school at my university. I started wearing glasses about a year and a half ago after I was diagnosed with astigmatism, and because my eyes don't line up with each other. So I currently wear glasses with a prescription for the astigmatism and a prism to get my eyes to line up better. I was also diagnosed with a convergence problem (meaning I have a hard time getting my eyes to focus together on things, especially up close), but I never went to the binocular vision clinic because it costs several hundred dollars just to get evaluated.

But I've been noticing issues with my vision that seem to be getting worse. At my last appointment, about three months ago, the optometry school was able to arrange things so that I could be evaluated by one of the binocular vision specialists as part of my free yearly eye exam.

They said that some of my problems are due to the astigmatism, and that I may need a stronger prescription. They also gave me a pretty thorough checkup for binocular vision issues. This included a worksheet where I would evaluate statements and then rate them on a scale of 0-5 ("Strongly disagree" to "strongly agree"). Lots of questions like "when I'm reading, I sometimes have to read the same sentence several times," "I have difficulty focusing," and "I have trouble staying awake when I read." The minimum score for considering treatment was 21. I scored something like 43. They concluded that I am a very good candidate for vision therapy.

The problem is that a lot of the things on the worksheet were also symptoms of a learning disability, and it turns out I was diagnosed with an executive functioning disorder as a child. And some of the symptoms of executive functioning disorders are that you may, for example, have to read the same sentence several times, and that you may have trouble focusing. So it's unclear if my problems are attributable to eye problems or brain problems.

The clinician told me it would cost between $1000 and $1500 to fix my convergence issue, but it would be a permanent fix. I just got a big deal scholarship (yay!) and I can theoretically sort of afford this, but it would be a major chunk of my funds.

I would like to be able to see normally. There is no doubt that I have a real vision problem; it is measurable and obvious. The only question is how much of an impact it actually has on my life. $1500 for a lifelong fix seems like a good deal, but at this stage in my life I can't afford to spend that much and find out I could have gotten by just fine without it.

My question is:

Has anyone else been treated for binocular vision therapy alongside a diagnosed learning disability? Obviously YMMV, YANMO (You Are Not My Optometrist), and each case is unique, but I'm very much in the dark about how much this will actually improve my life, and I'd like to know if anyone has had a similar experience. Did binocular vision therapy make all the difference in the world? Was it nice just to be able to, like, use binoculars without difficulty? Were you suddenly able to see in 3D for the first time (I can't)?

Or, as I fear, did it make things superficially nicer (like being able to see in 3D), but it was still just as hard to focus on reading as ever, and you still had to reread the same sentence over and over again? And even so, was it worth it anyway?

Or shoot, even if you don't have a learning disability, did BVT make a huge difference in your life?
posted by shapes that haunt the dusk to Health & Fitness (16 answers total) 5 users marked this as a favorite
Best answer: Caveat, I do not have problems with binocular vision but I do teach students with learning difficulty diagnoses.

The fact that you have got through school to attend university with your visual condition indicates that you are a very high achieving learner. I would suggest that is quite likely that your problems with reading have an ocular origin, which you have worked very hard to compensate for.

$1500 for a lifelong fix seems like a good deal

Oh hell yes! Better than good. It seems like a fantastic, 'you have no idea how great', deal!
For example, if a doctor said to me that I would lose my 3D vision unless I paid up $1500 x 10, I would be selling, borrowing and begging to raise the money.
posted by Thella at 1:16 AM on March 21, 2017 [11 favorites]

but it would be a major chunk of my funds.

Mate, you are worth it. Please take the opportunity while you have it. You really can't see what a difference it could make. It's a cheap gamble in the scheme of things. How much would it cost if it was not subsidised?

I mean, you could even make money out of it. Keep a detailed journal of the experience before, during and after treatment then create an advertising-based website with doled out posts edited from your journal.

This is a big thing. Don't talk yourself out of it for financial reasons. It is impossible to see the payoff from the pre- side of the fence. I can't speak to it personally, but as someone who has the privilege of reasonable binocular vision, it's well worth it. You are worth it.
posted by Thella at 2:47 AM on March 21, 2017 [4 favorites]

The fact that you have got through school to attend university with your visual condition indicates that you are a very high achieving learner. I would suggest that is quite likely that your problems with reading have an ocular origin, which you have worked very hard to compensate for.

This. I'm a special education teacher and it seems that you have largely taught yourself successful working compensatory strategies. That is awesome.

I would ask the doctors this question but IMO this is a thing you should do!
posted by yes I said yes I will Yes at 3:32 AM on March 21, 2017 [1 favorite]

I have no expertise in this, but if you're trying to tease out the cause for the learning issues you deal with, one question to think about is whether they manifest only in visual contexts. For example, if you're listening to audio do you also find yourself not focusing or having to go back and replay things ? If this is important to you, you might consider a consultation with someone who does specialize in executive function and see if they have other ways to differentiate between potential causes for symptoms.

This comment isn't meant to advocate for or against fixing the conversion issues (I don't have any personal experience there). On that question, the only advice I have is to get a lot of details from the people who'd be doing the vision therapy about what it involves, how it works, what the success rates are, and whether it will stop the deterioration you say you've been experiencing. (And whether they're able to take your financial situation into account at all. On which note, what does your insurance have to say about covering this sort of therapy, either as a vision treatment or as a learning disability treatment?)
posted by trig at 3:50 AM on March 21, 2017 [3 favorites]

Not sure what exactly you mean by 'being able to see in 3D' but I don't have proper depth perception and I can't tell which of the little animals is supposed to be floating in that test. If I found out that $1,500 would fix me up I'd do it in a second. You're worth it.
posted by fixedgear at 5:48 AM on March 21, 2017

I had surgery to correct my wandering eye as a young adult. The surgery was easy but life-changing. No more headaches from the struggle to make my eyes track. Better concentration. And I hit a baseball for the first time in my life; it so startled me that I stood there watching the ball in wonder instead of running to first base. Do it.
posted by carmicha at 6:14 AM on March 21, 2017 [1 favorite]

This sounds like a good time to seek a second opinion. I have no expertise in eyes but would think it might be wise to ask an ophthalmologist unless there's reason to believe optometrists know more about this kind of thing.
posted by lakeroon at 6:17 AM on March 21, 2017 [2 favorites]

I would ask about success rates. My son had a vision problem that kept him from developing binocular vision and part of the rush for his surgery was that some schools of thought say you can't develop it past early childhood.

That said, if their success rates sound reasonable, there are other schools of thought that say that you can improve your vision into adulthood and the difference in my child's ability to concentrate, write, read, etc. is astonishing. It's definitely worth pursuing, just stay aware that it might not be a guaranteed success.
posted by warriorqueen at 7:02 AM on March 21, 2017 [1 favorite]

Best answer: I recently posted a similar Ask regarding my child. I got some good advice there. Since you mention it, he almost certainly has some learning differences, which we're still in the process of sorting out.

Although others have given you some good questions to ask (especially since you're an adult) I can tell you that there have been marked improvements both at home and at school in his ability to attend to visual work. He is less resistant to handwriting, he is completing more schoolwork, and he has started reading so much I had to post a followup Ask for book recommendations!

In terms of the overlap between the eye problems and the learning differences, it is oh such a tangled web. But it's quite possible that your vision problems contributed to whatever symptoms caused you to be diagnosed with a learning disability. (Does that make sense?)

If you're interested in some "light" reading, you may find the book "The Mislabeled Child" to be informative. Although you are not a child, it is a thorough and accessible discussion of all the different pathways that can go wrong with memory, vision, hearing, attention, et cetera. Much of what it discusses is not specific to children, and it offers practical workarounds to deficits in each area. Most importantly, it also highlights subtle differences in (for example) the way attention problems present when they are due to vision deficits versus some sort of underlying executive function disorder. Although I wouldn't advise you to try and diagnose yourself, it may help you sort out your thoughts as you try to differentiate learning issues from vision issues.

Finally, the price quote which you have been given is well below what you would likely pay in other places.
posted by telepanda at 7:16 AM on March 21, 2017 [7 favorites]

I am not an optometrist, ophthalmologist, neurologist, or any other kind of medical-type person.

But because my mom worked for Torsten Weisel back when he won the Nobel Prize, I learned a little about how eyes and brains make us able to see. The tl;dr (the link has a decent rundown; see also here) is that some vision problems that babies are born with must be corrected as soon after birth as possible, because once the neural paths are laid, those can't be fixed. For example, if a kid is born with a lazy eye, even if surgery is done to correct how the eye appears, the kid may never see in 3D if the surgery is done after the neural vision path is set.

So. The surgery might work for you, but please get a couple more opinions, and do some reading on ocular dominance, before you make your decision.
posted by rtha at 8:57 AM on March 21, 2017 [2 favorites]

Best answer: There is a fascinating book written by a woman who gained binocular vision for the first time as an adult as the result of that sort of therapy. She gained an entirely new sense! Her memoir is called Fixing My Gaze: A Scientist's Journey Into Seeing in Three Dimensions and I strongly recommend it (though I've never had problems seeing in 3D myself). Here's a link to a brief NPR piece about the book. Oliver Sacks wrote the forward and was important in urging her to write the book. It would be fascinating for anyone, I think, but you in particular should read it.
posted by artistic verisimilitude at 9:37 AM on March 21, 2017 [5 favorites]

Response by poster: Thank you for the responses so far!

I do just want to clarify that this would not be surgery. This would be vision therapy, with an office visit every two weeks and about 20 minutes of exercises a day. The cost that I was quoted was based on the number of office visits I would likely need, including the initial visit where I was told to expect about three hours' worth of tests to determine a course of treatment.

One of my eyes does naturally point slightly lower than the other, which is what the prism is for, but I understand that my convergence issue may be a separate problem. I'm not sure if would still need a prism after the therapy or not.

As far as my attention goes -- I am pretty distractible. I have gotten distracted listening to podcasts, but it may not be all that unusual for someone to be easily distracted while listening to the BBC In Our Time podcast on Margery Kempe and English mysticism. I have no doubt whatsoever that I have a real learning disability, but I would agree that I seem to have learned to cope with it reasonably well. So that's where some of my confusion lies. Have I already done most of the heavy lifting?

I do also have the option of paying $300 or so for the initial evaluation and seeing what they say. None of this is covered by insurance, though -- and interestingly enough, apparently I was getting vision therapy as a kid, but my parents had to stop it because it wasn't covered by insurance then, either. So there's that, too.

But thank you for the responses. I'll keep mulling it over.
posted by shapes that haunt the dusk at 11:48 AM on March 21, 2017

Best answer: Hi, I have ADHD and strabismus with diplopia. Also astigmatism. The ADHD is severe, and the vision is relatively mild but it does cause problems.

As relates to the vision scoring test, for me the questions you mention would have far more to do with the ADHD, and little to do with my physical vision. Though I would not be able to tell the difference if I wasn't treated for ADHD.

Anyway, my eyes were not severe enough to require surgery as a child. The non-convergence wasn't even noticed until I was in first grade. I was regularly given very basic exercises to help at that time. Several years later I did a bit more structured vision therapy (primitive by today's methods) and had glasses for a short time. Then I lost them and did without for over a decade.

In my mid-twenties the eyestrain became a problem and I finally got glasses again. Correcting for astigmatism in both eyes. It was so nice to see crisply! At this point I have adjusted to glasses so much that I have depth perception problems without them. For me the astigmatism, with all the other stuff, isn't like what typical people experience. For me my glasses are more like retainers. I have to wear them all the time, or my eyes get worse and I have to readjust. It is frustrating that my eyes cannot be corrected to the same level of clarity, but I only really notice it when I am tired. I'm starting to get a bit of presbyopia, which compounds the problem of tiredness.

At this point, unless you get refractive surgery (like LASIK or PRK), you're always going to need glasses.

$1500 would be a bargain for better vision. And you do have the physical problems for which vision therapy can actually make a positive difference. If you have the money and it won't be financially damaging elsewhere in your life, it might be worth it. But if you would have to eat ramen for months, maybe not. I am wary because there's never a guarantee that therapy will work, and that they claim permanence. There is also a signifigant time burden as well. How many sessions? How often? Do you have the time? I'd want to know exactly what would be happening, and for how long, and what kind of results I could expect before I dove in.

On preview: You did find out more specifics. Good. I'm going to leave in what I wrote though because I'm having a bad writing day and it took me so long to write that I'd be sad to delete it.

To sum up, I don't know how much it will help. While I don't think it'll solve any problems conclusively and forever, it might give you another tool for coping.

FWIW, the first few years I had glasses my prescription changed frquently as I got used to not having to over-compensate, but did eventually stabilize.
posted by monopas at 12:07 PM on March 21, 2017 [3 favorites]

Best answer: Although we are still in the middle of it, I can offer a few specifics regarding what my son is doing for his eye exams and vision therapy.

Our course of vision therapy is currently estimated to run 6 months (this is the "average"). We have weekly office visits and eye exams every 6 weeks.

The exam includes: tests to see if he is seeing double, putting a graded prism in front of one eye and stepping it up while he tries to read an eye chart, to see how much of a difference he can focus his eyes through, checking 3d vision using polarized glasses and a special book, having him look through some sort of lens with a pencil in each hand and draw lines that are supposed to meet in the center (but don't if the eyes are seeing different things).

The therapy is 20-30 min/day and includes:

For the first few weeks, at home we did exercises such as:
- saccadic eye charts: a grid of letters where you read the leftmost column, then the rightmost column, then the second-left most column, etc
- far-near eye charts: a grid of letters on the wall and a small one in your hand; you read odd rows off the wall chart and even rows off the small chart
- "loose lens rock": you have a book and two lenses, a +X and a -X. You patch one eye, hold one lens in front of it and read a sentence, then switch lenses and read the next sentence, et cetera.
- Michigan letter tracking: A timed exercise where you read a paragraph of nonsense text and circle the letters of the alphabet in order. Over time you work down to smaller text and tighter spacing.

Now we have moved on to using a computer program, made by HTS I think. There are several different modules. Our current modules are:
- Saccadics/tracking: Rotated E's either float around (tracking) or pop up on the screen in various places (saccadics) and you hit the arrow keys as fast as possible to indicate the direction the legs are pointing
- Vergence base in/out: Wearing red/blue glasses, you look at a large square on the screen with a smaller square somewhere inside it that pops in or out in 3D. You click the small square. The red and blue images get progressively more separated on the screen, to stretch your eyes' ability to refocus and see where the small square is.
- I forget the name of the last one, but you look through a pair of lenses (you work up through several levels of lenses) at rotated C's and press the arrow key in the direction of the opening.

You do all these things as fast as you can, the program grades you on speed and accuracy, and adjusts the difficulty level accordingly. The optometrist sets which modules you work on and for how long.

In theory, the reason the therapy has a permanent effect is that once you have trained your eyes to focus correctly, they continue "practicing" all the time in the course of daily life.

I will say that you DO have to do the exercises religiously in order to get benefit from them. As an adult, you could probably manage this. Making a 6 year old do it daily has been like pulling teeth at times. But if you're going to commit the money you do need to be sure you can commit to doing the exercises EVERY DAY.
posted by telepanda at 12:56 PM on March 21, 2017 [1 favorite]

Memailed you.
posted by wiskunde at 5:58 PM on March 22, 2017

Response by poster: To follow up:

I finally went to the binocular vision clinic. They ran 3 hours of tests on me (including hardcore 24-hour dilating drops that made my vision suck for the rest of the day). They concluded that my vision is actually not that bad. My eyes are generally capable of working together OK. My 3D acuity is great. My astigmatism isn't all that bad, and my vision is pretty decent even without glasses. I was told that within the next 10-15 years I can expect to lose my focusing ability and get more farsighted, but even then, I won't need a particularly strong prescription.

There were two big issues that came up. One is that I strain a lot. I am constantly straining to maintain focus, and I'm constantly straining to keep my eyes working together. That is, my vision is decent and my eyes are capable of working together, but it takes work. To address this, the doctor wrote a new glasses prescription that falls somewhere between my first pair from a couple years ago (too weak) and the last pair I got (too strong). She also included a very mild prism in each lens that directs my eyes inwards. The new prescription, in conjunction with the prisms, should help reduce the constant strain of, well, seeing.

The other big issue is that I have difficulty reading. The doctor ran a test where I wore glasses that tracked my eyes as I read some short passages before being tested on information retention. The takeaway from that is that my eyes often go back to reread the same sentences. I knew that happened, but the test confirmed how often I do it. That suggests an issue (obviously), but it's hard to know whether that's due solely to a visual processing problem. I asked if it could possibly be cognitive, since I have been diagnosed with executive functioning disorder, and she said yes.

So, 3 hours and roughly $400 later (although there's an outside chance that insurance might cover it under my new plan), and I'm still not totally sure whether I have trouble reading because of my eyes or because of my brain. I can say that there appear to be no major vision issues, and I don't want to discount how important it could be to have glasses that effectively address what was confirmed to be pretty severe eye strain. "Eye strain" can sound like a minor issue, but it may actually be causing a number of problems. And in the end, $400 is a lot of money, but I probably won't need to get such comprehensive tests done again for a long time, if ever, and it's certainly not $1500.

A few people had asked that I follow up on my experience at the vision clinic, so I wanted to share that now. I still haven't gotten the new glasses prescription, but when I do, I'll give it a few weeks and see if there's been a marked improvement in my life. If nothing else, I'm hoping I'll at least get fewer headaches.
posted by shapes that haunt the dusk at 2:43 AM on November 8, 2017

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