Volume 110, No. 236                                     Insight - Section C                           Sunday, November 28, 1999

A Visible Difference 

Story by Debbie Blossom
Photos by Todd Stubing

With a tug on her eye patch, Edmond kindergartner Alexandria B. squirms in her swivel chair under the watchful eye of optometrist Dr. Doug Cook.

It's the youngster's fourth visit to Cook's Guthrie office, and the almost-6-year-old is overflowing with curious energy.  Then the games begin.  For 30 minutes, Cook turns his young patient's attention from one intriguing activity to another as he observes her ability to perform what seem like simple tasks. But as B. attempts to insert tiny pegs into holes in a rotating base and catch a ball suspended from the ceiling that Cook tosses her way, she is hardly playing.

Under Cook's supervision, she is learning to improve the visual function in her under-developed right eye through vision therapy. The training program is used to help correct such childhood vision problems as near-to-far focusing, tracking, scanning, lazy eye and crossed eyes and the inability to use both eyes at the same time.

B. was diagnosed with a lazy eye -- meaning her eye wandered and turned to the outside at 10 months, and she also was born with a birth defect that left that same eye's optic nerve endings shrouded under a layering of insulation.

"Her vision was blocked, and it never developed," said her mother, Donna B.

And while muscle surgery at age 3 helped steady her lazy eye, B.'s defect has left her with severe nearsightedness and very blurred sight in her right eye. She views the world only through her left eye.

At her therapy sessions, B. wears a patch over her seeing eye and uses only her undeveloped one while completing exercises that aim to strengthen her focus, peripheral vision and hand and eye movements.

Optometrists use a variety of techniques in their therapy, including computer programs, mini-trampolines, chalk boards, balance boards, stereoscopes and colored lenses and 3-D pictures to improve vision.

Last week, B. played several "games" like connecting lighted red dots on an electronic board and touching a small ball at the end of a slim pointer as she attempted to better the previous week’s progress.

At each session, Cook adds another game to keep his patient’s interest stimulated.

In four weeks, her vision has improved from 20/200 to 20/40, and a delighted mother says she can see the improvement in her daughter, who has seen several eye doctors in the past few years.

“Dr. Cook is the only doctor to recommend therapy for her,” Donna B. said.  “This is the most receptive she has been to anything.”

Vision therapy isn't new, but there are only about 600 board-certified optometrists in the United States trained to provide the treatments, according to the College of Optometrists and Vision Development in St. Louis.

"We're called developmental optometrists," said Cook, who has undergone additional training for treating vision problems. He has been certified to offer the service since 1991, a year before he and his wife, optometrist Dr. Lisa Cook, opened their clinic in Guthrie.

Helping children has always been his goal.

"Kids' problems are the toughest, most challenging aspect of vision care," said Cook, who is director of the state COVD.

Most of the patients who undergo therapy each week, either with Cook or his wife, are children with good vision and normal or above-normal intelligence who began having difficulty with reading and writing, copying from the blackboard in school and in eye-hand coordination. Routine vision exams indicate their ocular health is fine, yet learning problems at school persist.

"Some of these kids have had regular eye exams, and they are told they have 20/20 vision and their eyes are healthy," Cook said. "Most of these kids are quite bright, they just don't learn as well."

But after a different set of tests, he is able to pinpoint problems with focusing, eye movement and perception and prescribe treatment to improve visual efficiency and processing.

In children, vision problems usually surface as skipping words when reading, letter reversal and trouble comprehending words, although they may understand those same words listening to a story read aloud, Cook said.

"For vision to develop, it has to receive constant stimulation," he said. "People think vision is automatic, but it is a complex process that is learned."

And when something interrupts that process, children don't learn like they should.  For example, he said, children can't retain information they read five minutes before, they are easily distracted and they avoid detailed work projects.

Teachers often are the first to notice the problem, and they are often the ones who make the initial referral to optometrists. The internet has also helped promote vision therapy as concerned parents research their children's problems.

Most of Cook's patients simply sought out an optometrist's advice before discovering a diagnosis. "Nine out of 10 patients come in on their own," he said.

Patients usually attend one half-hour session a week, and treatments can last from a few months to a year. It all depends on the vision problem and how severe it is.

Cook stressed, though, that vision difficulties aren't the same as other learning problems like dyslexia and attention deficit disorder. "I don't treat learning disabilities," he said, although the two often go hand in hand.  

While therapy may not totally correct all of her daughter's vision

problems, strengthening her eye functions is a step in the right direction, Donna B. said.

"She's doing a whole lot better. We have to do everything possible to improve her vision at this age."

Parental involvement is important, she said, and exercises need to be done at home, as well as during weekly sessions. She and her husband have devised their own games at home, along with Cook's suggestions, to help Alexandria.

"You do have to support it at home, it has to be a partnership between a doctor and parents," she said.

"The exercises need to be done every day."

The B.s have their daughter fill toothpicks with pieces of cereal and match up identical dominoes to help her focus, improve her hand and eye coordination and identify similar items:

"You just try and get her to look in all directions and use her eye."

Problems caught early can most always be improved, or even corrected, Cook said, and the satisfaction comes when grateful patients and parents share their stories about success in school and uplifted self-esteem.

"After therapy, it's good to see them back a year later and doing well," he said. "The rewards are great."

Donna B. just wants hey daughter to have the best vision she can, considering her difficulties.

"We're very pleased with Dr. Cook. ... Alexandria responds to him," she said.

Getting a strong-willed child to wear an eye patch and attempt therapy can often be a challenge.

"We're doing everything we know to do, and we think she'll make it. We have great hopes for her."

(Debbie Blossom can be reached via email at dblossom@edmondsun.com)

Since Alexandria B. can only see vague, blurry images with her right eye, Dr. Doug Cook has her wear an eye patch during therapy, forcing her to use those underdeveloped eye muscles.

Putting pegs in holes while the game board is rotating is one of many techniques optometrists certified in vision therapy use to help their patients improve their visual system.

Guthrie optometrist Dr. Doug Cook directs Alexandria B. to touch the tip of his wand as he monitors her eye and hand movement. This exercise is one of many Cook gives his patient during her weekly therapy treatments at his eye care clinic.