What to expect on your first visit.

First Appointment: What to Expect

This visit is usually 2 hours, but may be only 1 hour for a young child or a patient with relatively mild vision problems, or 3 hours for patients that have had head injuries.

What to bring with you:

• Current glasses
• If you wear contact lenses, a copy of the prescription, or the boxes or vials, along with your case and solution
• Most recent optometric or ophthalmological records
• Related testing from your occupational, physical, or speech therapist, psychologist, or other professionals involved in your treatment
• List of medications and nutritional supplements

Your Vision History

We will start by talking about what is going on with your vision. When talking with pediatric patients, they have the opportunity to actively participate from the start of their vision care. This conversation is often an eye-opening experience for parents, as they listen to their child's visual experience in their own words. While parents' concerns have already been noted in the initial phone call, they are asked to expand on anything that came up during the conversation with the child, and other aspects of developmental and medical history are reviewed.

For adult patients, we are often told that this is the first time that they feel like they have been listened to about what is going on with their vision. This starting point is essential for planning testing, potential treatments, and any referrals to other professionals. Please be sure to bring a list of all medications and nutritional supplements that you currently take.

Vision Tests

The initial tests are conducted with hand-held equipment, allowing parents and family members to see what the optometrist sees. And since these tests aren't about passing or failing, but instead about finding out about how a person's vision is working, we call them "vision experiments." You'll recognize the familiar eye chart and bright lights, but there are several other tests that explore how the patient can move their eyes:

The things checked by every eye doctor:

• Visual acuity (Is eyesight clear at distance and near?)
• Refractive status (Are glasses needed to compensate for blurry vision?)
• Ocular health (Are the eyes structurally sound?)

If you've been to an eye doctor, you know that this takes less than 20 minutes, and might be wondering why we schedule so much time for our evaluations. We make sure to cover these essentials, but continue to investigate with more breadth and depth.

Everything else that we look at during the first visit:

• Ocular posture (Are the eyes straight? Do they have a tendency to drift in or out?)
• Eye teamwork (Do the eyes work together as a team? Is the teamwork easy or difficult? Is it better when looking far than looking close?)
• Eye fixation (Do the eyes hold still to maintain attention in one place?)
• Smooth eye movements (How well is visual attention held on a slowly moving object? Do the eyes interpret and direct movement in a person's environment with ease?)
• Eye tracking (Do the eyes move accurately and efficiently from place to place?)
• Depth perception (Does the visual system appreciate differences in distance provided by the slightly different perspectives between the 2 eyes?)
• Visual focusing (How well do the eyes obtain and sustain clear vision at various distances)

In addition to the "free-space" tests, visual function is also assessed with the phoropter (that big, clunky "glasses machine" that makes clicking noises as various lenses are clicked into place in the tubes through which each eye gets a view). For patients who are not able to participate in phoropter-testing (a very young child, a patient with postural problems, or a person who is currently not able to sit still long enough to look through the machine), we employ other hand-held test devices. In general, all the above areas of visual function are tested in a variety of ways, to identify and quantify any problems, and to ensure the validity of testing.

When a problem is found

When a visual problem is found during testing, it is brought to the attention of the parent and their family. While identifying a problem might sound like "bad news", the good news is that these problems can be improved in the overwhelming majority of patients. The relationship between the vision problems and the symptoms are usually easy to see.

For example:

• When a problem with eye tracking is identified, we can say, "This is why you skip little words when you read! That must be so frustrating for you."
• Or a problem with smooth eye movements: "No wonder it's so hard to write your ideas – your eyes don't like to move and tell your hand where to put your pencil!"
• Difficulty with eye teaming: "Your eyes don't like to pay attention when they look at things up close like books and homework."
• Poor visual focusing: "Your eyes want to stop working after you've been reading or writing for few minutes."
• And the good news after identifying each of those problems: "It's not your fault. Your eyes just aren't doing their job yet, and they can get better!"

What can we do to help?

We test for problems that we know how to fix. At the end of the first visit, you should have a good idea of what is working well and what isn't working well. You'll also have an idea of what is involved in fixing the problem. The easiest first step in treatment is often glasses.

Even for a patient that already has 20/20 eyesight, glasses might be helpful. Most of our patients either see 20/20, or have glasses that provide 20/20 clarity. Their problems do not reside in the part of the visual system responsible for clear central eyesight. Rather, difficulties with teamwork, tracking, and focusing are problems with the coordination and movement of the clear eyesight from one place to another. And problems with visual coordination and movement often lead to problems with processing of the visual signals, resulting in symptoms like poor visual memory, difficulty with multiple-step sequences, poor spelling, or difficulty with expressive writing.

Before we finish the first visit, we can try glasses (even for the person that already sees 20/20) and repeat some of the experiments to see if glasses will help.

Sometimes, glasses will be enough to help the visual problems, and a follow-up visit will be planned. Sometimes the problem is more complicated, and optometric vision therapy will be needed. Before we get started with vision therapy, we look even more closely at visual processing at The Visual Perceptual Evaluation.