Brendan's Vision Diagnosis

It has taken me a few hours to assimilate the information given to us by the vision specialist yesterday. If you will indulge me a bit, this post will likely be a bit more of a "rant" than normal. I am just gonna be frank here. Can I be Frank? Okay, just call me Frank! "Frank, you say... "

Yes, I am a bit punchy. I haven't had much sleep. I can't sleep. My mind is on overload and I am WAY stressed out. I am working on my trust issues with God. I do okay a lot of the time but after a night of tossing and turning, I don't have my normal ability to "cast all my cares upon Him". I know, I know...that's when I should be doing the best at it!

Our conference call with the vision specialist took place yesterday afternoon. Mom was in her office for the call and Randy and I were patched in. The whole via-teleconference thing was hard.

One of the first things she asked was if we had had Brendan tested for Aspergers Syndrome. I told her that we had indeed had him tested both by a psychiatrist and a developmental psychologist. Aspergers was ruled out. Over the two hour conference, she mentioned Aspergers many times. It was as though she couldn't get beyond her big idea that he had Aspergers! Her other points:

While Brendan sees 20/20 on a vision test, his eyes don't function together as they should. I am trying to re-create it the way I understand it so it is more understandable for folks without these issues.

The first issue is with eye movement. Most people have the ability to accurately follow a moving target and shift their eyes from one point to another with ease. Brendan cannot do this. It requires gross motor (movement of his head and neck) movement for him to function as opposed to fine motor (eye shift). The goal here was 50% - Brendan was less than 1% in vertical and 1-5% in horizontal. I know. Those numbers don't mean much to me either. I just know they aren't great! The diagnosis of this part of the exam was Oculomotor Dysfunction. Have you had him tested for Aspergers syndrome?

In real life this means that Brendan will lose his place frequently, skip or omit words, have a difficult time copying from the board and have a really hard time performing in any sporting activities. It is totally amazing to me that he can ride a bicycle and played basketball for many years - even making a basket every once in a while!

The next piece dealt with the ability to focus the eyes rapidly and automatically. Reading and writing both require the eyes to be able to focus for long periods of time. Coping from one place to the other (the chalk or marker board) requires a change in focus from long distance to near. Obviously this is also linked to the ability to sustain visual attention. The goal for Brendan was 10 cycles per minute. He was able to do 5. The diagnosis for this part was Accommodative Infacility. We really do need to consider the fact that he likely has Aspergers...

Probably the biggest piece of the puzzle was the binocular integration. God designed our eyes and muscles to work together with such a high degree of precision that both eyes perform as if they were one. This ability is related to eye movement control and focusing ability. Since both of those are off somewhat, it stands to reason that instead of working as a team, Brendan's eyes have some rivalry in the ranks! Sure enough, we have big issues here! We won the diagnosis lottery in this area and got a two-for-one deal: Binocular Dysfunction and Convergence Excess.

To accomodate, his brain just shuts down one of his eyes at near range. He is totally blind in one eye when he is reading or looking at things close up. He also has an extremely slow response in focusing on anything requiring fine depth discrimination - meaning his depth perception is way off. There is a good chance that Aspergers Syndrome has some meaning to his diagnosis.

Again, the test measurements don't mean anything to me but to give you an idea, the goal for far distance was 12 pd (prism diopters) and Brendan made it to 4. The goes for near distance was 25 pd and Brendan made it to 6. The time it took for the two eyes to fuse images to allow depth perception was 70 arc seconds (whatever an "arc second" is!) with normal being 20 arc seconds.

So, lets take a look at what that looks like for Brendan practically. This is what a white marker board looks like with a few words written on it.

This would be a typical assignment and this is how you or I would see it... Aspergers?

Now let's make it doubled like Brendan sees it...
And let's add in the "I-can't-focus-the-dumb-thing-so-it-looks-like-I'm-drunk" bit... I'm pretty sure this is how it looks to folks with Aspergers Syndrome.
And you get just a clue as to why he was barely passing in classes that required him to write notes off of the chalkboard! It makes my head hurt to look at just that little piece...image your whole world in full color looking like that...MOVING...for THIRTEEN YEARS! If that isn't overwhelming to you than you are way stronger than I am!

And then the doctor has the audacity to ask if he has Aspergers!! Uh, no, lady, he is on sensory overload from the vision issues you just told us about in great detail!

I was in tears. I cried a bit and then I did what all red-blooded American women do in a crisis (after the chocolate)...I picked up the phone...

• I called my sister. Dori is an RN. She has known Brendan since before he was born. Her husband is a school counselor. "Do you think Brendan has Aspergers?" "NO!!" I love my sister!
• I called my sister-in-law. Kim is an Occupational Therapist. Kim has many years of experience working with a child with autistic-like tendencies. She too has known Brendan since before he was born. "Do you think Brendan has Aspergers?" "No...I really don't. Why do you ask? I have a check list at home we could consult...I really have found that 'Aspergers' is the new catch-phrase for diagnosticians to use..." I love my sister-in-law!
• I called my BFF. Sandie is a teacher. But not just any teacher...she is the team lead for special education in a junior high. Sandie has known Brendan for five years. "Do you think Brendan has Aspergers?" "No! Who told you that?..." (I won't repeat the rest as I wish to keep this family friendly. Let's just say Sandie got a bit defensive on my behalf. I love Sandie!)
• I called my Mom. My mom didn't even know what Aspergers was. She had been sitting in the doctor's office listening in when the doctor had said that though and she remembered it. She went from there to the school. She walked into the office of Ms. Whorton, the Principal Sent from God. She told Ms. Whorton what the doctor had said. Ms. Whorton said something along the lines of "I really think that 'Aspergers' is the new catch-phrase for diagnosis when they don't know what else to say and I don't think Brendan has it." I love my mom... and I love Ms. Whorton!

Evidence based medicine and my critical thinking skills (thank you nursing school for those long words there - they keep me from sounding like I belong on an episode of My Big Redneck Wedding!) tells me that our son does not have Aspergers Syndrome. He does have some neurological issues. We will get therapy for those issues. The therapy may or may not work. If it does not work, we will figure out something else that will.

Please know that if at the end of the day he does have Aspergers Syndrome, we will still love him and I have absolutely nothing in the world against anyone with this syndrome. I just think with all the other issues he is dealing with, it is a bit ludicrous to pile something on that the child doesn't have just so you can slap a label on it and feel better about yourself! And at what point did a optometrist (even a developmental specialist in the field) gain the training necessary to diagnose Aspergers?