“He Saw A Top Doctor Who Said His Eyes Are Fine”
YY, a twelve year-old boy, flew in from Cleveland yesterday to consult with me. Actually it was his mother brought him in to consult with me, having family in Lakewood, NJ (the town in which I practice) whom I had helped. YY was struggling with reading despite being a child who was motivated to learn. He knew all the mechanics of reading just fine. He was simply the poster child for our bread and butter case: the bright student with a significant gap between intellect and reading capacity.
YY had been prescribed glasses an optometrist in the New York area about a year and a half ago which helped considerably at the time. Both YY and his mother felt that something had changed, and that his Rx probably needed to be adjusted. But there was a problem: Dr. OD had retired in the interim, and the word on the street was that the doctor who took over the practice was struggling to duplicate his success. YY’s mother therefore decided to take him to a pediatric ophthalmologist, a “top doctor” at the Cleveland Clinic. There she ran into a quandary. The top doctor said that YY’s eyes were fine, and that he didn’t need any glasses. Dr. OMD insisted that YY’s eyesight was perfect, and the bifocal and prism that he had were just “a thing” that some optometrists were into. So YY tried to go without the glasses, but his signs and symptoms were worse without them! YY’s mother felt like she was between a rock and a hard place.
Many of you have been on the long journey with me. It has been 15 years since I did a blog post on VisionHelp giving voice to this rock/hard place dilemma for parents, and not much has changed regarding the opinion of doctors (top or otherwise) who insist that everything is fine. The implication remains that those of us who prescribe lenses, prisms, and other interventions for vision based learning problems are merely Shakespearians, making much ado about nothing.
I do sense that the tide has shifted, particularly for children and their parents who have hit countless detours and dead-ends. I’m still a passionate advocate for what we do, but I’m less concerned about what “top doctors” think and their selective application of “evidence-based medicine” [so-called top docs often indulge in eminence-based medicine when it comes to their own practices, the subject for another day]. The light shines brightly at the end of my tunnel, and while I have no clue how many more years I’ll be at this, I do know one thing for sure: “Top Doctors” will continue to tell parents of children with overt or covert vision-based learning problems that:
- His eyes are fine
- His vision is perfect
- He doesn’t need glasses
- Prism is only needed when a child sees double
- Bifocals for children are only indicated for crossed eyes
- Vision therapy is not scientifically proven and a waste of time and money
Most times these days when presented with the “top doc” opinion I simply nod my head and say that I’m sure “top doc” is a very good surgeon, but when it comes to vision and learning it’s simply not their area of expertise. In this day and age, parents get that. No doc, not even a “top doc”, can be authoritative in all aspects of vision care.
In this particular case, there is a colleague in Cleveland who can reliably monitor the Rx I prescribed (per my letter below). After I summarized this with his mother, YY looked at her and said: “I only want to see Dr. Press. I don’t want to go anywhere else.” I reassured YY and Mom that he’ll be in good hands with my colleague in Cleveland, but that he’s welcome to stop by to say hi the next time he’s in the area visiting with family.
To: Mrs. XX
Re: YY
D.O.B. 01/22/014
D.O.E. 08/04/2026
Dear Mrs. X,
This is a synopsis of your son, YY’s evaluation in my office yesterday. The main concerns were difficulties with focusing and reading. On his symptom checklist you indicated that he has visual discomfort at near, tires easily, tends to skip or re-read lines, and dislikes reading.
YY has a history of congenital ptosis of the left eyelid, which is moderate, and which has no direct on his visual performance. He had previously seen Dr. OMD, a pediatric ophthalmologist at the Cleveland Clinic, who advised that he was not in need of any glasses. He is currently wearing glasses with a bifocal and prism prescribed by Dr. OD, an optometrist in Monsey, NY who has now retired.
My evaluation through YY’s glasses showed the following…
…Internal and external eye structures were healthy and normal in appearance in both eyes.
Based on the findings above, YY has convergence insufficiency with accommodative instability. After successful trial framing and both objective and subjective improvement in reading, I issued the following Rx:
OD: +0.25 -0.50 cx 165/0.5^ BU/1.0 BI/+1.00
OS: +0.25 -0.50 cx 035/1.5^ BI/ +1.00
I indicated that YY may wear his glasses full-time, but they will have their greatest utility for learning and focusing in the classroom environment, particularly at near. Given your proximity to an excellent colleague in the Cleveland area, Dr. OD, I suggested that he monitor YY in one year’s time.
Sincerely,
Dr. L. Press
Leonard J. Press, O.D., FAAO, FOVDR
Why Choose a Children’s Vision Specialist?
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