The good, the bad, and the ugly!

Yesterday I met Dr. T for a complete visual screening. My appointment took 4 hours and was quite extensive. He began by testing my peripheral vision then proceeded to check my visual acuity. Most of the time was spent measuring my eye to see the degree in which my right eye is "off" compared to my left. He used prisms to adjust the horizontal and vertical alignment of my right eye and measured to see how far "off" my actual vision was compared to where it should be in order to be in proper alignment with the left eye. He finished up the testing by dilating my pupils to check the overall health of my eyes.
http://www.lonestarvision.com/images/eye_anatomy.jpg

A lot of what occurred during the four hours was purely educational. Dr. T took time to explain each and every step of the process to me and help me understand why my brain has shut off the vision out of my right eye. Let me give you the good, the bad, and the ugly of his assessment.

First the good. Number one--even though I do not use my right eye to "see," my brain does use the eye to see objects in my peripheral field of vision. I noticed this was the case today as I drove to the appointment. As I was driving and focusing my eyes straight ahead, I could see objects entering and exiting the right side mirror. Curious about the awareness of this knowledge, I wondered if my left eye was seeing the right mirror of if it really was my right eye. I closed my right eye and looked out of my left. To my amazement, I realized that there was no way my left eye could see the right driver's side mirror; my nose was blocking the view! When I closed my left eye, ever so briefly, I noticed that I could still see the right side mirror in my peripheral vision. This was the first time in my life I was aware of the fact that I had usable peripheral vision in my right eye. The tests I performed in Dr. T's office confirmed this fact. I had normal peripheral vision in both eyes.


More good. The fact that I had not had eye surgery before has increased my chances of having a successful eye therapy by 50%. That's huge! I may need eye surgery later on; but for now, my eye muscles are right where God placed them and they should respond nicely to therapy.


What's really promising is that my eyes do work together some of the time. The doctor found out that I can "turn on" both eyes when I look at objects about 3-4 inches from my face. He was able to tell this because when I see objects this close, I immediately see double. This demonstrates that I do have SOME binocular vision--even if it is an ever so small amount. Until my eyes are straightened and I can focus on one object with both eyes, each time I use both eyes, double-vision will occur.


The other good news is that I was fairly consistent in my ability to "line up" objects while using the prisms. Dr. T had me sit behind a device called a phoropter and he adjusted the lenses to achieve visual acuity. He then used various prisms in my right eye so that I could tell him whether the image I saw out of that eye was lower or higher (for the horizontal position), or up or down (for the vertical position) from the object I saw with my left eye. Because he was able to get fairly consistent results, he would be able to use prism lenses to help correct the misalignment in my right eye.



So what is the bad news? The bad news is that my right eye hasn't been used for a VERY long time. It may be hard to awaken it and get my brain to decide to use the visual input from that eye when processing visual information. There is a chance my brain will decide that it just will not do that. If you look at the diagram at the top of this page, you will notice a very small dot behind lens of the eye. It is called the fovea -- it is what our eye uses to help us focus and see objects. Basically, the fovea in my right eye does not work. My brain has shut it off. My brain does use the other parts of my eye to see peripherally but refuses to use the part for focusing because it cannot match up the image from my right eye and left.

I saw how stubborn my brain was during the assessment. When I was aligning the objects using the prisms, as soon as the object would get in close alignment with the object in my left eye, I would lose sight of it in my right. My brain would simply shut down the image in the right. It may be that my brain will be resistant and even defiant when it comes to working with me. Let's pray that is not the case and that my brain will welcome this new input and incorporate it into my vision.

The other bad news is that I will have to wear prism glasses 24-7 during my training. I have always hated to wear glasses because I am significantly near-sighted in my right eye, so the lens looks like a coke bottle and the magnification needed to help my vision also seems to amplify my strabismus (or cross-eyed condition). Cosmetically glasses worsen my appearance and bring more attention to my strabismus, so I really fight wearing them. The doctor assured me that the prism glasses would help my vertical alignment and the vision therapy would help my horizontal alignment, so the lenses should not amplify my strabismus. They should help! I was also concerned that wearing prisms would look really funky. You know, I could use my glasses to make rainbows on the walls or kill ants outside! I instantly had this view of prism glasses being like the prisms we used in science class! He told me that they will look like regular lenses; the only difference is that I will need a frame that goes all the way around the lens because certain sides of the lens will be larger than the other. This should not be detectable to someone looking at me though.

Unfortunately, my insurance will not cover the cost of the visual therapy. Because Dr. T is not a perferred provider with any insurances, I will probably have to be responsible for about 60-70% of the costs. This will cost us considerably, but to someone who has been blind in one eye from birth, the possible benefits WAY out weigh the cost.

Now for the ugly. The ugliest news he shared with me is two-fold. First, the training will be long, hard, and require every bit of concentration and dedication on my part. He did not even want to consider beginning this training unless I was entirely motivated and would pledge to do my exercises routinely. The exercises will be done at home on my computer, for the most part. He uses an online program that he can monitor my progress and make adjustments to my training. I will also have to come in for appointments twice a week to begin and when school starts, it would drop to once a week.

The other ugly news is that there is a chance that we can invest all the time, effort, money, and energy into the visual therapy and my brain and eye will not respond to it. That is why he offered a six month trial period. If I am willing to give this a go, we will do as much therapy in six months and then re-evaluate to see if I have made enough progress to proceed.

With that said, I have a big decision to make. Do I proceed with the six month trial or, after taking all the risks and investments into account, should I call it quits and live with my blindness for the rest of my life (after all, I have lived this way for 43 years already)?

So if you were me, what would you do?