We see many children in our office that could have been diagnosed earlier.  In many cases, parents of these children were given a false sense of security because a rudimentary vision test administered at the child’s school (usually by a nurse) had determined that the child had 20/20 vision.  That determination may be correct as far as it goes but a rudimentary “vision screening” cannot test for the 15 visual skills covered in a developmental optometrist’s examination.

Many children have needlessly struggled through school for many years with a treatable vision problem that was finally caught when the child had an optometric eye health examination.

Note that not all optometrists are trained in or practice vision therapy and consequently, they may not examine their patients with a view to determining the need for vision therapy.  Patients and parents should ask the proper questions:

• Will the eye examination evaluate binocular muscle strength?
• Will there be an evaluation of eye-teaming skills, focusing ability and eye movement and control?
• Will there be any visual perceptual testing?
• Will the visual information processing system be evaluated?

Convergence insufficiency disorder often goes undetected because it is not tested in a  pediatrician's eye tests, school screenings or basic sight tests.  Dr. Randhawa always tests for convergence insufficiency disorder.  Make sure you ask your eye doctor the right questions.

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Diagnosis of vision problems that can be treated with vision therapy

Another important point is that not all professionals are trained to assess ocular motor abilities or visual perceptual deficits.  For example, the authors of a study published in the scientific journal NeuroRehabilitation cautioned that patients should be referred to an optometrist not an ophthalmologist (eye surgeon) for a proper evaluation. 

The study states that patients "should be referred to a behavioral or neuro-optometrist. It was also noted that referrals made to an ophthalmologist may be insufficient, as they are primarily concerned with the health of the eye only, and ophthalmologists are mostly experienced with acute medical problems rather than rehabilitation issues. This assertion is supported by considering the typical components of an ophthalmologic exam, which may yield a lack of specificity, and/or provide information which is inadequately defined in terms of rehabilitation consequence. Trobe, Acosta, Kirscher and Trick identify a lack of measurement in areas of distance and near acuities, contrast sensitivity and confrontation, while Gianutsos and Matheson describe a need for greater quantification in terms of field gradations and boundaries, and binocularity conditions. A more thorough investigation is important for the rehabilitative efforts of all patients who demonstrate visual processing deficits."

The study authors go on to state that "[o]phthalmologists are excellent surgeons and expert at treating acute disease but their expertise does not to extend to the diagnosis or treatment of visual processing deficits."  Individuals who go to a doctor for an evaluation or a second opinion need to ensure that they go to the right doctor.  Some doctors may tell the patient that there is nothing wrong when they have not performed the necessary testing.