Case #10

A 10 year old boy (grade 4) presents with both parents who claim that he has had difficulty with reading and has been tested by the school and found to be 2 years behind grade level in comprehension. His spelling is also a problem.

The parents indicate that he sometimes uses a finger to read and that he looses place.

When questioned the boy indicated that he did get confused but didn't loose his place when reading. He did say that the words did "funny" things when he tried to stare at them. When asked if the words ever seemed double, he said yes. To a question about the words being blurry, he said no.

 

Additional history?

 

Clinical findings:

Unaided distance visual acuity

20/20 O.D. / 20/20 O.S.

Unaided near visual acuity

20/30+3 O.D. / O.S.

Cover test

5 pd exophoria / - kinetic cover test

Stereopsis

40 sec

NPC

5 cms / no diplopia at break

EOMs

full in extent

Refraction (O.D./O.S.)

O.D. +1.00 / O.S. +1.00

Distance phoria (H/V)

1 exo / ortho

Near phoria

5 exo

Near BI/BO fusional vergences

BI: 14/18/6 BO: x/20/0

MEM (unaided)

O.D. +0.75 / O.S. +1.00

Accommodative facility (cpm)

O.D. 6 / O.S. 6 (+ more difficult)

Additional tests:

Additional ocular motor tests:

DEM

vertical score: age level

errors: 14 (2 rows omitted)

ratio: 1.5

SCCO

2+ saccades and pursuits

NSUCO

? (a prediction?)

Questions: 1. Interpret these results. 2. Compare the results of the 3 "oculomotor" test. 

Management: Include details of an initial VT program, if applicable.