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Uncovering a Frequently Overlooked Diagnosis: Oculomotor Dysfunction

Oculomotor dysfunction is a commonly overlooked diagnosis, but fortunately, there are specialized doctors who can identify and effectively treat the condition. My son Jacob showed a passion for reading at a young age, even before he could read. He would sit with his “Thomas the Train” books and his toy reading glasses, imitating my reading habits. He excelled in reading throughout his early years, but then things began to change gradually.

Initially, Jacob was an excellent student and enjoyed school. However, during his later grade school years, he started expressing his dislike for school, although his grades remained good. I began to notice some signs, like him not answering questions on tests or not completing homework. He was also clumsy and uninterested in sports, but I didn’t think much of it. In middle school, his grades started to decline slightly, and he lost his love for reading. He even expressed that he didn’t want to go to college. I was confused about what happened to my once enthusiastic reader and good student. Did he become lazy and unmotivated?

When Jacob entered high school, his complaints became more severe. He experienced frequent headaches, nausea, difficulty copying from the board, trouble focusing, and exhaustion within minutes of reading. He thought he might need reading glasses, but he struggled to describe his vision problems.

We visited an eye doctor who prescribed reading glasses, but even after several months, his vision remained blurry. That’s when he mentioned that words seemed to move around. He became increasingly frustrated as he struggled to explain what he was experiencing, and I didn’t know what to do next.

A turning point came when a friend, Marilyn Tonkin-Stickler, a speech pathologist, mentioned that her son had dealt with something called convergence insufficiency, which sounded similar to Jacob’s complaints. This sparked our research journey, and we discovered a website that discussed various eye issues. On the site, there was a quiz that strongly indicated Jacob had vision problems. We also watched video clips illustrating how these conditions appeared for those who have them. Jacob was excited as he realized that his eyes did all of those things, finally able to explain his struggles.

Fortunately, Marilyn recommended several doctors who specialized in these issues, and we found one locally, Dr. Jacqueline Theis. Dr. Theis had personal experience with oculomotor dysfunction, having dealt with it herself since the age of 13 following a concussion. Jacob’s first visit involved thorough testing, revealing not just one, but six different vision issues. Dr. Theis diagnosed Jacob with accommodative insufficiency, functional convergence spasm, vergence infacility, saccadic hypometria, smooth pursuit dysfunction, and reduced vestibular-ocular reflex gain. During the examination, Dr. Theis asked if Jacob had any prior brain injuries or concussions, and he recalled a fall in second or third grade where he hit his head. This fall was likely the cause of Jacob’s problems.

Dr. Theis explained that Jacob exhibited classic post-concussive vestibular-oculomotor dysfunction. While there’s a possibility he had these issues since development, his symptom patterns and physical symptom provocation are more common in traumatic cases than developmental cases. Surprisingly, when I shared Jacob’s situation with my aunt Kimber, she realized she had almost all the same symptoms. She still dislikes reading, experiences brain fog and sleepiness within minutes, and disliked school, even avoiding college due to her symptoms. It’s disheartening to think how many others might have similar undiagnosed conditions.

Treatment for eye movement disorders can be complex. In severe cases, surgeries or prism glasses might be necessary. Fortunately, Jacob’s treatment was simple, and Dr. Theis had a 95 percent success rate with similar patients. Jacob’s symptoms disappeared completely within weeks to months, and they haven’t returned.

Oculomotor dysfunction is often missed because patients don’t always have typical vision symptoms. It can manifest as headaches, car sickness, inattention, or anxiety in visually crowded areas. Symptoms are present, but they might not be associated with the visual system. Patients are sometimes misdiagnosed with conditions like migraines, anxiety, ADHD, or cognitive impairment when the underlying issue is oculomotor dysfunction. Additionally, the appropriate eye exam is usually not performed, missing the opportunity for diagnosis.

This is why seeing a specialist is crucial. Dr. Theis conducts comprehensive oculomotor testing to accurately diagnose the specific eye movement abnormalities causing symptoms. Her examination assesses the accuracy, speed, and stamina of each eye movement direction and looks for abnormalities that may be causing symptoms.

Jacob initially struggled with the therapy exercises, experiencing severe nausea and dizziness. However, with adjustments and progress checks, he showed significant improvement. To boost compliance, I created a chart for Jacob to track his exercises, which only required 5-10 minutes daily. This, along with his symptom improvement, motivated him to continue with the treatment.

Today, I’m happy to report that Jacob’s symptoms are completely gone, and his vision is back to normal. He has rediscovered his love for reading, and his grades are excellent again. Oculomotor dysfunction is a frequently missed diagnosis, but with the right specialist and treatment, it can be resolved effectively.

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