VISION AND EPILEPSY

By Dr. William Moskowitz

As is well known, epilepsy is a neurological problem. What many people may not recognize is that an impaired neurological system often has a negative impact on how effectively one uses both his eyes together and interprets what he sees. An impaired visual system diminishes motor skills, alertness and attention, which are all recurring problems for epileptics. Chris' story is just one example of how a subtle vision problem had widespread effects on a person's life.

Christopher L. was a bright child (with petit mal epilepsy) who wasn't working up to expectations. He would attempt to read, but was discouraged by his inability to recall what he read. He would also become confused if not given enough time to complete his work. Despite wearing glasses, he would still lose his place and have to reread the material, sometimes several times. The ability to read directions, from a visual standpoint, requires an even higher and more accurate degree of scanning and sequencing. Since Chris did not have these skills, he frequently failed tests primarily because he could not follow the directions.

Prior to Chris' examination by a developmental optometrist, he had been told that he had perfect vision; that is, he read the 20/20 line on the eye chart. (What that means is that he could see at 20 feet what a person should be able to see on an eye chart at 20 feet). This, however, is just one of the many visual skills required for learning at any age. And although Chris' eyes were found to be healthy, he did not track accurately or as quickly as he should for his age. These deficiencies were more problematic for Chris because of his [heretofore undiagnosed] seizure history. That is, more effort was required for him to read and therefore more stress was created on his already fragile visual system. The examination also found that Chris had an insufficiency in his ability to turn his eyes inward; that is, he was not aiming his eyes directly onto the words he was reading. Chris was actually looking past the page just as if he were staring out into space.

When all the data from the developmental optometric examination was interpreted, a pattern of what is called visual behaviors unfolded. It now became imperative to correct the functional deficits in the way Chris was taking in information through his eyes. It was not possible for him to utilize the images from both eyes at the same time. He was, in reality, only partially seeing. A carefully designed program of optometric vision therapy, to be carried out in the optometrist's office, was developed.

During the course of therapy, Chris exhibited visual behavior found in those who are prone to seizure. He was referred to a neurologist for a definitive diagnosis - petit mal epilepsy.

Chris prospered while going through vision therapy. He participated in activities where he learned to improve the quality and accuracy of his eye movements. Visual images relating to memory, which Chris had been suppressing, were now becoming available to him. The ease with which he now understood what he was seeing and interpreting improved dramatically. He found it easier to concentrate and to understand what he read. In addition, Chris' visual attention and listening skills (and, consequently, his grades), vastly improved. Others (his teachers, in particular) noticed that he was more alert. The future for Chris suddenly seemed brighter. He enthusiastically spoke about achieving goals (such as becoming an architect) that had previously been beyond his reach.

Vision problems (such as suppression) in epileptics are often subtle and are not even recognizable by the individual. A behavioral optometric examination, which evaluates a person's neuro-visual functioning, can yield rich rewards in the form of improved daily living skills and the ability to meet future challenges for both children and adults.

BIOGRAPHY

Dr. William Moskowitz is a board certified developmental/behavioral optometrist who has been in practice for over forty years, providing specialized services for children with vision-based learning problems, as well as adults. He trained at the Gesell Institute at Yale University and is an expert in pediatric developmental optometry. He has lectured internationally and was a contributor to a textbook on pre-school vision. Dr. Moskowitz, whose practice specializes in the diagnosis and treatment of vision-based learning problems, is a popular speaker with parent and professional groups. Individuals and groups can contact his office, the Park Vision Therapy Center, at (908) 725-1772, or his Vision Education Coordinator, Nan Miller, at (609) 882-6987.