The Older One was the first to notice it.
“Have you ever watched her eye?” he asked one evening when we were watching yet another viewing of the cinematic masterpiece, Bolt, with the Young One.
“What?” I sat up, intrigued by a good mystery. “You mean Penny?” I asked, referring to the movie’s animated heroine and thinking he was giving me some new detail in the movie I hadn’t seen in the first ten viewings.
“No, the Young One,” he pointed out. “Sometimes when we’re watching TV, her eye will kinda go out. Sorta like a lazy eye.”
I turned and looked at the Young One who was oblivious to our conversation. Nothing happened at first, but after periodically glancing her way, I saw it. One minute both eyes were trained on Bolt’s frantic race to find Penny, the next, the iris and pupil of her left eye started a slow drift out and up.
My mind quickly flashed to The Exorcist, and a chill went down my spine. It was three years later before we finally got a diagnosis that didn’t involve demon possession.
Strabismus, or wandering eye, is sometimes difficult to spot in young children. Kids are great at adapting, and often, as was the case for the Young One, the turn of the eye is so subtle, even doctors don’t see it.
So, for three years, both her pediatrician and optometrist told me, “Let’s just watch it for now, and see if it gets worse,” which, of course, it did. Shortly before she started first grade, we finally got a confirmation of an exotropic strabismus (an eye turn to the outside of the eye, as opposed to the more common esotropic strabismus or crossed eye).
The good news was we finally had a diagnosis and could seek treatment with a specialist. The bad news…many experts believe that by age seven, the only effective treatment is surgery. The Young One had turned seven just a few months earlier.
Fortunately, the specialist we were referred to is a proponent of vision therapy and believes that with repeated exercise, children can learn to control the eye turn and retrain the brain.
“About 5% of kids have some degree of strabismus, ” he told me. “The first thing they will experience is double vision. You have binocular vision,” he said, pointing at me. “Both of your eyes are aligned to the same position when you look at an object, so your brain processes one image. For her,” he turned to the Young One. “Both eyes don’t align to the same position. Each eye sees an object from a slightly different view, and the brain processes two separate images. This creates double vision. To counteract the double image, her left eye turns off, and that’s when you see it slide out.”
Technically, this double vision is called convergence insufficiency, and when she reads, the words look like this:
He went on to list the signs of this eye suppression: clumsiness, poor depth perception, tilting the head while looking at an object or while reading. As children enter school and begin reading, they will often skip words or entire lines of text. Their handwriting is often sloppier than their peers’. They also have a tendency to very quickly say, “I can’t” when faced with a new task because they have learned over time that new tasks are frustrating.
As he talked, I recognized every sign, but like many parents, I had attributed them to the fact that she’s a child. Kids spill things. They’re just learning to read and write, so you can’t expect them to be perfect. That head tilt? That’s just a quirk of hers, right?
A lot of things started to make sense–like how she stumbles over simple words, skips entire lines. If she’s tired, she gets frustrated and says what she’s reading makes no sense. I’d be frustrated and confused too if this is what the words on the page looked like:
“How did this happen?” I asked, assuming I had done something wrong. I had been 14 years between children. Maybe I had forgotten a few things.
“Well…”the doctor paused and looked at the new patient questionnaire I had filled out in the waiting room. Then he flipped to the Family History section where I had left all the questions blank.
“How old was she when you adopted her?” He asked quietly.
“Not quite 13 months.”
“Did she ever crawl?”
I sighed and shrugged. Crawling was one of those milestones, I never got to see. When we met her in Russia, she was eight months old, and while she would rock back and forth when we put her on her hands and knees, she never went anywhere. I didn’t see her again for five months. By then, she was standing and cruising around the room using the furniture for support.
Crawling, the doctor explained, usually occurs at about the same time as binocular vision develops. A child who doesn’t get enough tummy time and isn’t encouraged to crawl is at a greater risk of developing strabismus because the eyes don’t have a chance to become a team. A crawling child is not just moving. She is usually moving toward an object she has spotted and focused on which helps binocular vision develop.
I never saw the Young One crawl. I have, however, seen plenty of pictures of her taken in the orphanage–pictures of her jumping in bouncy seats, nestled in strollers and sitting in high chairs. I can imagine that a baby’s life in a Russian orphanage doesn’t include free reign to roam wherever she chooses.
Pirate practice? No, just patching exercises for vision therapy.
So, as the pieces fell into place for me, the doctor walked me through what would happen for the next 12 months–weekly sessions with a vision therapist to learn exercises and strategies for controlling the wandering eye, supplemented by nightly exercises at home.
We’ve been at this now for eight months. I am more attuned to the signs that her eyes aren’t working together–the head tilt, the frustration when she loses her place while reading, the constant fidgeting while reading (a result of the brain being overstimulated by conflicting images). I pay attention to the eye turn more often too. When I look at pictures of her, I look at the eyes first.
She is learning to live with this too. At first she didn’t like having this thing that makes her different. “No one else at my school has to go to vision therapy,” she often complains. Finding time for weekly appointments and nightly vision exercises in addition to school homework and sports practices is challenging for a busy girl, and often the cause for pouting and whining.
But slowly, I can see things starting to change. She is proactively asking to do her nightly reading assignments for school, and she skips fewer words and lines than she used to. When we do the exercises at home, the left eye doesn’t turn out quite as often as it did when we started, and more and more I am finding pictures with both eyes focused on the camera.
It’s taken eight months, but I’m finally seeing some progress. I’m hoping she starts seeing the improvements too…in more ways than one.