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odd perceptual problems, see an FCOVD?

(also posted in expert forum)

What type of specialist should one see if eye tracking issues are
suspected?  That is, when the anatomy is normal but the neural pathways aren't
quite right to coordinate the eyes perfectly at all times.  We recently
read "Fixing my gaze" which mentions Optometrists who are fellows of the
COVD (FCOVD), who specialize in this sort of thing.  Start with them, or
is some other type of specialist more appropriate?

My son has a lot of medical issues of which (mild) asthma is the only one with a definitive diagnosis.  He has some peculiar large lightly pigmented patches on his back and sides, which no pathologist or dermatologist can
readily explain.  He has the occasional migraine.  He still, in his mid teens, gets ear infections.

On top of all of that, and pertinent to this forum, he has visual disturbances.  "Everything looks flat" or "everything looks unreal".  (Never double vision.)  Three neurologists and an ophthalmologist thought it was migraine like. But it is very atypical. It lasts months, slowly waxing and waning,  and does not respond to migraine drugs.  Stress and  fluorescent lights make it worse.  Vision tests are normal - just a tiny amount of astigmatism in
one eye.  Static depth perception tests (cards and such) are normal.  He has had two head MRIs, an  EEG, blood tests, urine tests,  Lyme disease test, etc. etc. etc. All normal.  We would go see Dr. House at this point, if he was only real.  The strange stuff all started when he was 10, before that it was just asthma.   Despite all this, and missing a fair amount of school, he gets good grades.

"Fixing my gaze" described some eye tracking tests so we tried them on him and he said they made him feel terrible.  Looking back and forth between two beads on a string may be annoying, but it shouldn't make him
dizzy, and it did.  So  we suspect he may have, for whatever reason, a subtle problem in eye coordination, and that is why we want to verify this or rule it out.  Who to see to do so?
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Avatar universal
After a lot of visual testing the FCOVD OD came up with a lot of normal visual parameters and a few pretty subtle defects.  Not surprisingly these defects are things that would never be picked up in a normal eye exam, but they show up here because this office has all sorts of special equipment for testing the dynamic aspects of vision.  They do make some sense in terms of the visual problems my son reports.

1.  Slower than normal accommodation (each eye individually)
2.  Much slower than normal accommodation (both eyes together)
3.  Slightly asynchronous eye tracking.  [He never has overt double vision.]
4.  Slight tendency for his eyes to overshoot the beginning of the next text line when they scan back while reading.

His accommodation tests normal even in this office on the typical sort of "look near, look far" test, and his depth perception is also normal on nearly static tests, since these both allow the patient seconds to adjust, but when he has to focus in and out fairly rapidly he is apparently slower than normal.   They said his ability to focus near to far was slower than far to near.

What sorts of conditions cause slower than normal accommodation?  He has had two MRIs and there definitely isn't an "egg sized left subtentorial arachnoid cyst", which was a single case, and the only report I found with Google of a disease state that resulted in slow accommodation.

Thanks.
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Avatar universal
The ophthalmologist he saw _was_ a neuro-ophthalmologist.

Our working hypothesis at the moment is that there is a subtle neurological deficit in visual processing in his brain.  (What causes it - we have no idea.)  There is an outside chance that specialized eye training might strengthen enough connections in the affected pathways to reduce or eliminate the perceptual problems.  According to "Fixing our gaze", with the proper training even adults have enough plasticity that they can attain stereoscopic vision, even if they had never done so normally when they were very young.  So we will give an FCOVD a try, as the only real danger from this type of eye training is to our bank account.
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711220 tn?1251891127
MEDICAL PROFESSIONAL
Try a neuro-ophthalmologist.

Dr. O.
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