Intermittent Esotropia in Toddlers: A Parent’s Vision Therapy Success Story with Vance Basilio

When Vance Basilio noticed his toddler son’s eye suddenly turning inward, what began as intermittent esotropia gradually became a diagnosis of partially accommodative strabismus. After early reassurance from providers who focused only on eye health, Vance continued searching for answers and eventually found a developmental optometrist who evaluated Luca’s visual function more comprehensively.

In this episode, Vance shares their two-year journey of glasses, vision therapy, and intensive daily home practice. He discusses suppression, accommodative vs. non-accommodative components, measurable progress over time, and why their family chose a functional, long-term approach rather than surgery.

If you’re navigating a new strabismus diagnosis in your child, this honest parent perspective offers clarity, encouragement, hope, and practical insight.

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Transcript

Denise: Welcome to the Healing Our Sight podcast. I'm your host, Denise Allen, and today I have with me Vance Basilio, and he is here to share his story of his son Luca. I met him because he messaged me on my podcast. And I was so thrilled because on one of my former podcasts, I said, please send me a message. There's this little spot you can click on. And I love it because it comes as fan mail, and he's one of the few people who's done that. So, thank you for doing that, Vance.

Vance: Yeah, I was excited. I wasn't sure you'd respond. Cause you were this big podcaster, and I would listen to all of your podcasts. But when you replied, I think the next day, I was just so happy to start that conversation with you.

Denise: Yeah, well, when you say I'm this big podcaster, you know, anyone can do a podcast, right?

Vance: It takes a lot to keep it going, so. And honestly, like, we'll get to it later, but it's just been a godsend to have your podcast. I always talk about the patient perspective being, like 50% of this journey. And so, I've loved it.

Denise: I appreciate that so much. That's the whole reason I started. It's for people like you. And just the willingness that you have to come on and talk just means so much to me.

Vance: For sure.

Denise: So, tell us how this whole journey started.

Vance: Yeah, for sure. So, my son was born in 2020. He was a cesarean, slightly premature. And I mentioned these details because they become relevant later on. And he also was in breach. Right. So, we've got three things. But he was delivered. Everything went fine. You know, the first two years, he hit all his milestones. We did a lot of the visual activities that you do with the baby, the tummy time, everything. And right about two and a half years, I'd taken him for soccer. And when we come back from soccer, he's at the kitchen island just eating his food. He looks down, looks back up, and his eye is fully crossed in. And it was myself, my wife, and my mom in the kitchen with him. And we all just had three very different reactions. So, my mom thinks it's just a funny trick that a child's playing. So, she tells him to, you know, snap out of it. She kind of snaps her fingers. My wife, I think she instinctively takes a picture, just knowing this might be useful later on. And I basically, like, go back to my computer and I'm like, researching. My go-to is like, research what is happening. And I think what was really good at the time was every single YouTube link, Reddit post, Facebook blog, everything said the same thing. This is not a one off. If it's one eye crossing in, this is strabismus. It does not get better with time. Go get it checked out. So, so three very different reactions, but that's how we first saw it, you know, and he, he did snap out of it really quickly, like within a few seconds. And I think the temptation as a parent is to think that, hey, this is just a one off. It'll blow over. And so, we really didn't do anything. We didn't see it again for maybe another month. And this was back in May. And so, in June, we see it again. He's in the car in his car seat and he's looking at us and I'm like, okay, so it's, it's, it's not, it's not gone away, it's coming back. And then, you know, it goes from being once a month to twice a month to every week. And when I get to the every week point, I think that was in August, we go and see our family doctor. And our family doctor, she's really, really good. She immediately tells us this is strabismus. Go see an ophthalmologist. And at the time, I think it was really good because my dad was actually in contact with one of the best ophthalmologists in Canada. Right. And so, I'm like, hey, we got the best of the best working on this. And so, we book an appointment, we get a rushed appointment, I think in August itself, which is very rare in Canada to get it that quickly.

Denise: Yeah.

Vance: Um, but when we go and get. The ophthalmologist should check it out. He's like, oh, it's. Eye structures are fine, retina's fine, everything's beautiful. No issue. And my wife comes back because she went for the appointment and she's like, yeah, everything's fine. But I knew just from reading everything on Reddit. I mean, thank God for, like, Reddit. I mean, it's all people that complain about your business, but you need that at the initial phase to know that things are not okay. Even when an ophthalmologist says it's okay.

Denise: Right.

Vance: So we basically didn't do anything after that as well. We said, you know, we've gone to an ophthalmologist. What more do you do? But it was his daycare that actually started coming back to us. The teachers in his daycare, saying, hey, his eye is crossing in and out while he's at school. So, I'm like, hey, this is progressing. It's not getting better. He's not snapping out of it or learning how to keep his eyes aligned. And so, I go to one of the highest rated optometrists in my area and book an appointment. I think this was now October of the same year. And I think, again, a good thing with Reddit is they told me everything that you're supposed to be looking for, what the optometrist is supposed to be checking. And this optometrist did none of that. She was dilating his eyes. She was kind of. She didn't mention strabismus once in the whole session. She said, you know, his eyes seem fine. Let's just put plus 1.5 glasses on him. And I was like, what's the plus 1.5 base down. Because I knew how they were supposed to go and figure out the lens. And she's like, we'll just see if it's too strong, we'll dial it down. But it was just not at all how you're supposed to do this. There was no cover test, there was no stereopsis test. And these are just words to me. But I knew she hadn't mentioned it, so that's when I knew I needed to get a better optometrist.

Denise: Yeah, well, a different kind of optometrist, right?

Vance: Yeah, yeah, that's one way to put it. I mean, through the first stages of, you know, going through. And the world's. I mean, the country's best ophthalmologist, and then one of the highest rated optometrists, the fact that none of them mentioned strabismus, none of them said esotropia, none of them said any of those words, I still find that very confusing. And it's something I haven't come to terms with because now for, like, a parent, we've actually had two parents just in our neighborhood come up and see that they are experiencing this issue. I give them the whole load on exactly what to do and how to do it. So. Yeah.

Denise: Yes. Well, they learn about it in school, but they don't specialize in it. Right. And so, they're focusing on structure of the eye, diseases of the eye, those kinds of things, instead of the function of the eye, which is just the developmental optometrist, that will do that.

Vance: Right, exactly.

Denise: So, at what point did you find the developmental optometrist? I mean, how did you find her, I guess?

Vance: Yeah. So, from that last optometrist visit, it's Kind of funny. I actually just walked out of the, of the clinic and I was like, I don't think you guys know what this condition is. And so, they were quite surprised. They were kind of fitting him with glasses. And I was like, the 1.5 to start with seems very strange. It's not based on anything. So, I walked out, and it was really by chance, you know, I started looking, I started becoming more strategic with how I look for the optometrist. I was looking for people that mentioned strabismus on their website, that mentioned esotropia, that mentioned vision therapy. Vision therapy was a brand-new word for me. All I had seen on Reddit was surgery, surgery, surgery, surgery. Right. And my wife was very, very against surgery. She's like, that seems like a plan Z. Like, let's start with plan abc, right?

Denise: Yes.

Vance: And so I found Elite Vision Therapy, which, you know, is a, a clinic that Dr. Peddle works at, who you've had on your podcast. And we went to her in October, the end of October, right before Luca's birthday. And it was just the best, but also the scariest appointment because she said everything, she did everything that was supposed to be done. And she kind of like first, for the first time, said the word he has strabismus. And she said it's intermittent partially accommodative esotropia. You know, like just going three levels down. And I remember going to that appointment, I was hoping it was purely accommodative, which means, you know, you put the glasses, it's done, you walk away. But when she said it was partially, I knew that was. I knew the non-accommodative part was there. That was going to take years to work on. Um, so it was scary in that way. But I'm really thankful because she's actually 10 minutes away from me. So, I'm going to that clinic back and forth all the time, just even bounce ideas off. They're very open, very, very friendly. And so just to have that proximity, it's one of the, I think, the main reasons why we've made so much progress in the last two years.

Denise: That is amazing. And too bad you didn't find her at the very beginning, right?

Vance: Exactly. I often wonder, like, if I found her in May, I mean, I did take a break between seeing the eye turn and going to find someone just to see if it would resolve on itself. But even if, you know, in August I'd gone to her, I. Who knows? We would have saved a lot of time.

Denise: Yeah, well, it's really hard to say. And some of the developmental optometrists don't want to start vision therapy until the child is five or older, right?

Vance:  Exactly.

Denise: And how did that part of it work out? I mean. Cause I think that a lot of people are maybe afraid to start that young or the doctor's not willing to, or there's just a lot of different challenges when you're working with that young of a child.

Vance: Yeah. So, when we went for the appointment, she kind of said, let's start with the glasses, because the glasses would resolve the accommodative part of Luca's esotropia. So just for your audience, like he has two things that he's working to resolve. It's one, the accommodative part, where, you know, if he's looking at something close, his eye will turn in, but he's also got distance component where there is a latent deviation, which means the resting position of one of his eyes is actually inward and not centered like most people's eyes would be. Um, and so when we put the glasses on, I think I had this incorrect notion that everything was going to be fixed that I still had in my mind. Like once the glasses were on, we were done, I would exhale and this whole thing would be behind us. But that obviously was not the case. So, before the glasses, I'd say in December, because we had to order the glasses, his turn was getting significantly worse. I mean, it was becoming every day. And then at one point, right in the middle of December, it was like constant, full of like six hours, eight hours. And that's when I really started panicking. Cuz the progression from May to December was just insane. It was just getting more and more intense. And you read about the fact that, you know, if this goes on long enough, there might be amblyopia, the eye might actually switch off completely. So, I will say like once we put the glasses on, it went back to being intermittent, which is what his turn is like. Basically, if it's something up close or something in the distance that he needs to focus on. Um, and so, you know, I messaged her,  Doctor Peddle and I said, “hey, we've put the glasses on. Great job. It's gone from a constant back to an intermittent, but it's not gone yet.” She's like, “oh yeah, it's not gonna go just like that.” I mean, I think throughout this whole journey you'll see her kind of say like, “hey, it's not gonna go away just like that.” And me being like, “hey, why Isn't it gone yet?”  It'll be this constant back and forth.

Denise: Yeah.

Vance: But she mentioned, you know, like, the vision therapy part is the part that addresses the non-accommodative part. And so, she said, he's really young. He's three, and vision therapy is expensive. And so, she said, it's up to you guys how you want to approach this. You can do at home. I'll give you all the material and you can do it on your own and try to get him to respond to some of it, or you can. And so, we started with the in home for maybe about two months. Um, but very quickly I realized I didn't know what I was doing. Um, I didn't know, like, what to look for. And so, we, we said, okay, let's just do the in office. I was like, I don't mind spending the money because if it's going to help him at this early of an age, I'd rather take that gamble than wait. She was open to it. She found a great vision therapist in her office who is really good with kids. And I think that's really the key. In one of your podcasts, someone talks about the relationship between the vision therapist and the child and making it fun. And this was like the most fun, open, extroverted vision therapist. And she almost became, like Luca's best friend. And she loved to go there just to play games. You know, if he wanted to take it slower, she would take it slower. And she wasn't looking at me being like, hey, I've spent money for this. Like, go intense with him. That was really good. We did, I think, 20 sessions in his first, in his first year, and then another 20 in his second year. And I will say the first 10 sessions, it's trying to get him to be still and focus on activity for. For a long time. Right. For 45 minutes. And so, we didn't see a lot of gains in the first 10 sessions. Um, but then by the 20th session, really things started picking up. And by the 30th session, we were making massive gains. And 40s, where we kind of finished off.

Denise: Okay. And you have, like, all of the details about where he is right now, too, which I. I think a lot of parents don't even know what any of those numbers mean, right?

Vance:  Yep.

Denise: Um, do you want to share some of that with the people who would understand what that means and then maybe explain a little bit of what. What that is?

Vance: Yeah. And I can kind of explain what the numbers mean as well. Just for some of your listeners who don't know. So, when he went for his initial checkup in October, he had a latent deviation of about 15 diopters, which I find incredible because for two and a half years his brain has, was overcoming that 15 diopters of deviation to keep his eyes straight. Um, and what that means is his eyeball is 15 diopters inward, like that's its safe resting place. And then when it wants to get fusion, it basically like straightens out and then he can see straight. So, he's got this constant 15 diapers that he's fighting with on his right eye. Right eye wants to go in 15. That's a safe space. It wants to like just relax and chill out over there. And when he went for his initial exam, he had zero fusion and zero stereo. I mean, he probably had like a high-level fusion, but he definitely had zero stereopsis. And what that means for your listeners is he couldn't see in 3D. And obviously I've never not seen in 3D, so I don't know what that feels like, but I'm guessing it looked, feels like looking at a photograph of something. You don't see that depth between the trees and the mountains and the sky and everything, so.

Denise: Right.

Vance: And I remember thinking, I was like, maybe he's just too young. But then I, I had my second child, and she was 2 when I took her for the exam, and she had full stereopsis. So, this is definitely unique to him, like, or unique to people with strabismus. So, he had no stereopsis and had 15 diopters of esotropia. The glasses resolved, I want to say like five of that. So, it brought him down, brought him to like a 10-diopter deviation. And then we've just been working with vision therapy over the last two years and now it's at about a five diopter. And I don't really know if we're going to get it to zero. Maybe we will in the next two years. But where it is right now, he's able to get fusion. So just over time, I will say, like the 40 sessions of vision therapy that we had, the first 20 were getting rid of that suppression. So, it's basically keeping both my eyes pointed straight. And even if there's double vision, that's okay, um, because you want to fight through that double vision to line them up. Instead of the brain saying, hey, I'm seeing double, let's shut one eye off.

Denise: Right.

Vance: Um, by the 30th session, we had gotten really good fusion And I'd say from sessions 30 to 40 he got stereopsis and then his stereopsis became really incredible. Like he was getting 50 arc seconds, which is really fine stereopsis, fine 3D. And he was able to hold that stereopsis through very high angles of basin, which means they're really pushing it to see how much can your eyes be apart and you still can bring them in and get that stereopsis. So yeah, a lot of gains. Yeah.

Denise: That is amazing. So, is that 50 at all distances or is that just at a certain distance? I. I'm assuming they're just checking it at that one distance, right?

Vance: Exactly. Yeah, they're checking it like from me to like a computer screen distance. I think it's like 60 centimeters. But we've been able to test it even like, you know, I have it on my computer right now and test it at different distances. And he's able to hold that 50 arc seconds pretty well.

Denise: That is awesome. Well, that's within the normal range, right?

Vance: Exactly.

Denise: Yeah, yeah, yeah. And I didn't get that information from my doctor initially. I think a lot of doctors don't give their patients those numbers. Right. And so I actually asked my doctor recently, hey, what is mine? And he. And mine is about that for near. Right. But for far away it's not as good. And so that's what I'm still working on is the distance stereopsis.

Vance: Gotcha.

Denise: So that's awesome.

Vance: Yeah, it's been a lot, it's been a long journey. So, I mean, I think when you look at it overall, you see the gains and you're like, wow, we, we have done a lot. But when you look at it day to day or week to week, they're very small gains just over an insanely long period of time.

Denise: Right, yeah. Well, so was there a point in time in there where you, you said, oh, well, that's his natural resting place. Maybe we should do surgery because then it will be easier for him to hold it where it needs to be or how did that all play out?

Vance: Yeah, I will say like surgery was this concept or this option that was at the back of my mind the entire two years. And my wife was very admin that we're not doing it. It's kind of funny because her personality type is not to do a lot of research and just to trust that motherly instinct. And for me it's the complete opposite. I've read, I think every single blog video post on strabismus that there is, like article, medical journal. And I think the thing with surgery is at this age, it's a huge gamble because you don't know what is triggering the strabismus. Is it the fact that the natural resting place is inside? Okay, let's say that's plan A. That's option A. Right. So, the natural resting position of the eye is in. If you take it out through surgery, you're shortening the muscles on the exterior, and you could go too far, cause an exo, you could cause a hypo or a hyper strabismus. You could make it ten times worse.

Denise: Right.

Vance: And when you're doing vision therapy with that overcorrection, it's much harder than if it was at the natural resting place. So that's option one. Option two is maybe the brain is just over accommodating. They call it like a high ACA ratio, which is you're over accommodating for every diopter that you want to accommodate for. And so, if it's neurological, then changing the natural resting place doesn't change the brain's behavior to over converge. And so, you could do surgery, bring it out, and the brain's like, whoa, now my eye is way out. It won't register it as being center. And so, it might want to bring it back. Right. Which is actually what happened to one of his classmates who had strabismus. I think at eight months, they did the surgery and it was fine. And now at two-and-a-half, it's going back in. And so now they're like, hey, what do we do? And so, I told them, get the glasses, go to Dr. Peddle and see what you can do. So, yeah, but I think that's easier said than done because you say, I want to do surgery and you do this vision therapy, but it's not like vision therapy fixes everything instantly. You have regression at time when the child. The child is tired and the eye turns in and you're like, maybe, maybe surgery could fix this in one day, and then the next day, I don't have to worry about any of this.

Denise: Yeah, I think that that's the common response, though. You know, everyone wants the quick fix, and they think that they're doing the best thing for their child. I see it so often in all of the Facebook strabismus support groups, Right? 

Vance: Yeah.

Denise: And that's what the general narrative is. That's what they're hearing from the ophthalmologist or the optometrist. Normal optometrist. Right. Is, oh, that's going to fix it. And even afterwards, they'll be on those Facebook groups saying, oh, I did the surgery. It fixed it. My child is fine now. And I'm thinking they might be fine today, but what's it going to look like in five years, 10 years, 20, 30 years? Right. Because you've done some, added some extra trauma to the eye. Right? That doesn't fix what was going on before, which I think also was caused from trauma. Is that kind of your take on it also?

Vance: I think what I've learned now, it's been two years that I've been through this process, and I've seen a lot of videos on strabismus surgery as well. I actually watched this one. It was a documentary in New Zealand where the child had done surgery. And the ophthalmologist says, okay, we did the surgery. It looks great. Now let's hope the brain develops fusion naturally and holds it there. And that, to me, was just the most. And this is a public documentary. He's saying it willingly. I'm like, how can you hope that it holds and doesn't revert? And I think that's what a lot of the ophthalmologists, from the videos I've seen, they do the one surgery and then you never talk to them again, maybe in one week after, just to see that everything's healing well. But never again.

Denise: Right.

Vance: To me, it's so worrying because the amount of work that we had to do with Luca to get fusion and to get stereopsis, that was two years of daily work. So, in some cases, for sure, the brain will latch on. But I think that's 5 to 10%. I think 90% of the time, you've gotta train the brain to develop that fusion and stereopsis.

Denise: Right. And we don't have any percentages on it. Right? Because no one ever tests any of that.

Vance: Yeah.

Denise: And then, you know, all of the. Those of us who've gone through a lifetime of strabismus are looking at it, going, wait, why? Why should we believe any of you?

Vance: Yeah.

Denise: Yeah.

Vance: And I just wish the two of them would talk to each other. Right. Because I do think there is a place for surgery in the sense that maybe you did a year or two years of vision therapy with the glasses, you know, changing prescriptions to find that sweet spot. But maybe the angle is like 20 to 35 diopters, and maybe bringing it in, if you're bringing a 35 down, you can get it down to like a 5 or 10 without too much risk, and then do vision therapy to lock in that fusion but if it's like a 10 diopter, you don't want to do fusion and under overcorrect and go the other way and make it an exo. And now even just the baseline vision is distorted. It's not just when focusing.

Denise: Right. Well, I. I know several cases of people who were eso as babies, and they were overcorrected, and then they ended up being exo for the rest of their life. Right.

Vance: Yeah.

Denise: And, I mean, that was Melissa's situation, too. Melissa Daniels. Right.

Vance: Yeah.

Denise: And then she ended up with vision therapy, surgery and more vision therapy, just like I did. Right. And I think it makes sense when we're talking about adults.

Vance: Yeah.

Denise: A lot more than when we're talking about children, because they're still growing and developing and learning, and it's, I think, an easier process for them to learn how to see correctly.

Vance: Yeah. And their face is growing in size. Their. The space between their eyes is changing. The whole world is changing so much. I don't think it's advisable to go to surgery, at least initially. Like, maybe if it's, like I said, a 30 diopter and you want to get it down to a 10 and then do vision therapy. But I think vision therapy needs to bookend it at the start and the finish, because that's. That's what really keeps the eyes locked in. It's not the surgery. The surgery gets it to where it needs to be so that vision therapy can line it up. So, yeah.

Denise: Yeah. I love that. So, as you're doing vision therapy with your child, who was the one that was most involved in the actual day to day making sure that that happened? Was that you, or did your wife? Or did you do it together?

Vance: No, it was just me. Yeah, it was just me. I had done so much research on it, and every time we went to a vision therapy appointment, I would talk to the vision therapist for, like, 10 minutes after each session. I was in the room with her, seeing what she was doing. And then she'd always go 10 minutes over and explain everything that she was doing, why she was doing it, what I was supposed to be looking for. So, it was only me doing it with Luca every day. And, you know, initially we were like four times a week, then six times a week, and now we're at seven. Like, we're doing it every day in the morning. Um, and I think, you know, it's a progression because initially when he was 3, he'd obviously be able to do, like, 10 minutes max 15. And even then, it wasn't that intense or productive. But you kind of develop this relationship. So, him and I, we have this incredibly strong relationship where we can work on really big complex things, all the time. No matter what he wants to do, we, we can talk to each other in a way because I think I've been talking to his brain for the last two years, like almost bypassing him. I'll give you an example. Like when we were doing the GTVT chart, which is a chart with red and white letters, and you put these red and green glasses and it's basically to ensure that your eyes can see both at the same time and not overlap them. At one point I noticed he was turning his head to kind of make it easier for him to view the GTVT chart and even things like that. It's almost me talking to his brain and like correcting his head. He doesn't know what I'm doing it, but it basically helps him do the exercise correctly. And so, I always say like the home VT, it's really important that you a present for the office VT as a parent to know how to do the home VT because he could have gone a year with turning his head and doing GTVT and completely missed the point of it. Or I actually worsened his strabismus because now he's got this compensating head movement to see.

Denise: Right. Well, I think parents don't always pay attention to the way the head is moving anyway. Right. Because that can be not just during VT but in regular daily activities. We're not always conscious of our children doing strange things like that. So, it's great that you are so involved and so hyper aware of all of that. I think that that's amazing. And I mean, how many parents are in the room with their child when they're doing vision therapy? Is it common in that office?

Vance: No, not at all. And, and I don't want to compare and judge, but you know, I see a lot of parents, they will drop their child off, I mean that 3-year-old or 4-year-old and they'll close the door. Parents outside on their phone and I'm like, how are you going to teach? How are you going to do home VT? Because your child for sure is going to want to cheat and get through it quickly. Every child at that age is going to want to just get it done with. They don't care about their eyes being aligned at 4 or 5, right?

Denise: Yes.

Vance: And I wonder like, how are you going to find those small really tiny things. Like, I remember with Lucas, vision therapist, we were trying to do fusion. Right. For a really long time. And I kind of mentioned to her, I was like, hey, he loves animals. Just randomly, I think I heard one of your podcasts that talked about bringing the kids interest into the VT room. And I just met. I was like, hey, he loves animals more than anything on this planet. And she developed this game where she put an elephant on one side and a box on the other side, and she used a mirror to kind of get him to put the elephant in the box through his mental acuity.

Denise: Uhhuh.

Vance: And his participation just tripled overnight. He was just put the elephant in the box. I want to put the bear in the cage. I want to put this in that. So, it's really important that you bring the home to the office therapy, and the office therapy to the home. You gotta have that.

Denise: Yes. You know what? I think that is so powerful, and I think parents can apply that to any activity. I mean, I'm a piano teacher, and my piano students that have their mom at the lesson do way better than the ones who drop their child off, especially if the parent knows how to play the piano also. Right. So, the fact that you're learning how to do VT because you're observing everything that they're telling your child to do is huge.

Vance: Yeah. And I go for piano classes as well, and I think about the fact that 95% of my gains happen at home. Like, the 5% when I go to the class is she's telling me exactly what to do, what to practice. She's correcting small things, and then she's like, go home and do this. Repeat it for six days. Right?

Denise: Yeah.

Vance: So, I think there's a misconception that office VT is gonna address strabismus. When I think it's office VT is gonna teach you, as a parent or as a patient, how to address strabismus.

Denise: Yes. That's so true.

Vance: Yeah.

Denise: When you were choosing your optometrist, I know you found one of the very best, but did you go to a bunch of different ones, or how did you come to that decision after, you know, going to other doctors and not getting any of the answers that you wanted?

Vance: So, the first one that I went to, that wasn't good, she was just highly rated on Google reviews. Right. So, I had just found her through the reviews. Everyone said she's perfect, but you gotta think of it in two different buckets. It's like the optometrist that prescribes glasses and does a really good job prescribing glasses, or the optometrist that works to resolve that case of strabismus. So, there are two different types of. Absolutely.

Denise: Absolutely. Right. But were there any other developmental optometrists near you, or you just. You were just so fortunate that she was the one.

Vance: Honestly, I think it was like a miracle that I found her, that she. I mean, I was obviously looking for proximity because Luca was three. I didn't want to go and travel very far. And so, it just worked out. And, you know, I always think, even as I got to know Dr. Peddle and the vision therapist, things only became better with time. It wasn't like they got worse and I'm just like, I gotta switch to another optometrist. So, I think it was luck.

Denise: We always hope that we're all also lucky. Right?

Vance: Yeah.

Denise: I feel the same way, because my doctor, when I started going, was literally around the corner. He moved his office a little bit further away, but it's still like 10 minutes. Right. And so instead of five and. And I think it's the same kind of thing where it's. You're just meant to see that doctor. They're just the right person for the job.

Vance: Yeah. And you think about. I always tell parents now, if you're looking for an optometrist for strabismus, make sure that the optometrist is talking aboutsStrabismus 24/7. And you see Dr. Peddle go on the road. She's meeting with Pilar (Vergara) to do sessions. She's meeting with you. Like, I didn't mention you when she somehow found you, or you found her. And she's talking about strabismus on podcasts. She's doing lectures on it and that I watch. She's writing papers on it that I read. And so, you want someone that's thinking about it 24/7, because I think it is a 24/7 resolution path. It's not something like, you take this medication and it's resolved.

Denise: Right. Well. And these are doctors that, when they're not able to resolve it right away, they're talking to their colleagues.

Vance: Yeah.

Denise: And they're doing their research. They are thinking about it 24/7 in relation to who they're helping.

Vance: Right, exactly.

Denise: So, tell us a little bit about how the vision therapy has been going lately and what you're expecting moving forward, because you've gotten a lot of what you. You were after, right?

Vance: Yeah. So, I can kind of talk about how Luca's progression was over the last two years. So, you know, when we first put on his glasses, like I mentioned, it was trending towards becoming a constant turn. And then it became intermittent. We started vision therapy, and we started seeing a lot of games. You know, he was able to, like, do Lego without an icon, which is. It seems simple for a child, but with a child, esotropia for a parent, it's very worrying. You know, when your child's playing Lego, you're like, is this I turn? Like, I gotta get on my knees and kind of see? Yeah, he was making a lot of gains. And then the gains started to slip, and I started getting really worried. And later, when I talked to Dr. Peddle, I kind of realized why they weren't slipping. But he was moving from daycare to kindergarten. He was dropping the nap that he had in daycare and now going a full day without a nap. And that nap, I realized even now it's so important to reset his eye alignment. He was playing with large toys in kindergarten to drawing and doing very, very fine work in school. And so it wasn't that his. He was having a regression. It was that his day was getting significantly more and more complex and demanding. Now he's in senior kindergarten, he's playing a lot more, running a lot more, getting more tired. Right. So, I think it was this journey where he's making massive gains in VT, but also his demands are getting so much more. So, it kind of looks like you're making no progress or actually making negative progress. So, I think what really anchored me in those, during those times was we had a checkup with Dr. Peddle every three months. And on paper, I'm seeing the gains. So, I think that I was just like, I'm gonna trust these gains. And now he's at this place where his endurance has built up. His automate, he's more automatic with how he can keep alignment. It's not as forced for him. So, I think just going through that journey and knowing that there will be ups and downs, like, one day he might be able to color and draw without a turn. The next he might be really tired and have a slight turn. It might be flickering. Right. So, we're not at that point where he's at a hundred percent resolved. I think he's at like a 95%, because about like six and a half days of the week, he. His eyes are perfectly lined up in all scenarios all the time. And I'm constantly VTing him, hey, look at that. But I don't actually care about what he's looking at. I'm looking at his eyes when he's looking at it.

Denise: Yeah.

Vance: And it's usually only on like a Friday end of day, in a demanding situation now where he'll have a turn because he's, you know, he's gone through five days of school, he's exhausted, and we're okay with that. You know, we're like, this Friday evening is. I know there's going to be a turn in if he's coloring or doing Lego, but I would like to resolve that. I think just the. I'm an engineer by trade, and so I think just the engineer in me wants to finish the project and move on. So, I don't know if I.

Denise: Like, that explains a lot of things, actually.

Vance: Yes. I don't know if I'll ever let it go, but, yeah, we're really good.

Denise: That is awesome. When you talk to the people that you mentioned, what do you tell them? Because we're going to pretend that all the people that are listening are in that same situation. I mean, and a lot of them probably are, and that's why they want to hear your story.

Vance: Yeah, I think it's really tough for me to tell a parent how to go through this because out of all the people I know, I'm definitely the most intense person I've met. And let's say if I'm a hundred percent intense, I went like 500% intense for this. So just, I don't. I can't expect anyone to do this. I mean, we do 45, 30 to 45 minutes of VT. Very intense VT every morning in our basement. You know, we are doing VT when he comes back from school. It's not with VT tools, but, you know, it's with Lego. It's with animals that he plays with. It's with drawing, with coloring. It's constantly monitoring his eyes and trying different ways to get alignment. Like, we found that if his eyes turned, I found a trick over, I think, six months, that if he looks away and slowly brings his head in, he can keep that alignment. So small, things like that. I don't think any parent is going to have the time to be with that child just so often. Like, I work from home, so I get that opportunity to be with Luca when he's home.

Denise: Okay.

Vance: There's also the optometrist. Like, we were lucky that she was 10 minutes away so we could go weekly and Luka not put up a fight. We were lucky that his vision therapist was so friendly and fun, that he loved working with her. We were lucky that we had saved money to pay for VT and not, you know, if Dr. Peddle said, hey, he needs another 10 sessions, I was like, book it. We're not gonna wait. So, I think it's a lot, and I think for parents, just give yourselves grace, that it is a very challenging condition to resolve and you might give it a hundred percent and still not see the gains you're looking for. But I think that's okay as long as you're moving in the right direction. I think with time, things will get better and things will, will resolve as long as you're just being there every single day. I. I read this quote where it's repetition, reinvention, recommitment, like every day. You gotta repeat, reinvent what you're trying to make it work and then just recommit. I'm gonna do this again tomorrow.

Denise: Yeah, that's awesome. And Dr. Peddle did give you the option of waiting and doing VT when your child was older, right?

Vance: Yes. I think she was more worried that I would spend all this money because it is very expensive. And, you know, Luca maybe would not be engaged or throw a tantrum or, you know, not want to do the VT in the office. He might run out. But I will say I was extremely, extremely lucky in that Luca, by nature, is very focused. He wants to, like, spend two hours doing one thing he wants to. He's very challenge-oriented. So, he wants to beat someone. You know, if I tell him, hey, your Randot score is 13, I need you to get a 15, he will come every morning and be like, let's get to 15. And like, how many kids are like that? Because my daughters are the complete opposite, if I tell them to do one thing, they'll do the other. So, I think just his personality type was just perfectly lined up for VT. And in resolving this, like, he. If he comes back home and he has a turn with Lego, I'll kind of take them away and try to line it up. And like, how many kids would leave what they're doing to come back later? And so, it's just.

Denise: That's so true. Yeah, I, I think that's a really good point. You have to know your child and yourself, like, what. What is going to work with our situation? Right. Yeah, that's. That's critical.

Vance: Yeah.

Denise: And I think that's a, that's a good point about why it works for some people and not for others too, you know, and they'll say, oh, well, I tried, “I tried VT (quotation marks). and it didn't work for me.” Yeah, but it takes a lot of commitment. I think that's one of the things you've really demonstrated today.

Vance: I say that with a grain of salt because I wonder if I was the one with Luca’s condition and I'm a very intense person, like I mentioned. And after the first year of just spending this money, of doing this daily VT, if it wasn't fully resolved, I don't know if I would have pushed through. And you know, you have all these other things that you're thinking about. You're like, I have work. I'm on camera for my work. There are people around me. I don't know if I would have pushed through because it was really by the end of the second year that the massive gain started happening. I mean, the ends were happening in the first two years, but I, I often wonder, I was like, maybe I would have just gone and got surgery and I, I, I don't think it would have worked, but I would have just been so needing that solution that I don't know what I would have done. I think the benefit with a three-year-old is they have very few things that they're doing in their day. They're playing and they're sleeping.

Denise: Right.

Vance: Eating. Right.

Denise: Eating, yeah.

Vance: They don't have too much that they're like, oh, I gotta get. They have the space to do VT and to line their eyes up. Like that's his whole thing for the last two years has been alignment. Right. And he has that space for it. I, if I had through business, I don't think I would have that same amount of time.

Denise: That, that's a good point too. Yeah. I think that that's a plus for doing it when they're young. As long as, as they can focus.

Vance: Yeah.

Denise: And I think that that's going to vary from child to child.

Vance: And because he had, because we were doing VT before kindergarten, before writing and reading, he was able to almost like grow with writing and reading and find work with VT. It's not like he had developed a turn with all of these activities and then we had to like unravel all of them. So, in that way, doing it at 3 really helped him grow with VT.

Denise: That, that totally makes sense. So, are you seeing that this is going to be something that you're just going to continue to do as kind of a natural practice in your home?

Vance: Yeah. So, we went for our latest checkup with Dr. Peddlel. I think it was in December of last year. You know, he hit perfect stereopsis. He hit all of his milestones. You know, the latent deviation like I mentioned is still there at about like five to eight diopters. So, I don't really know if that's gonna reduce or you know, if his eye is just like hey, I'm, I like keeping my eye here when there's no fusion and when there's fusion I can easily snap it in here. And so, I think the good thing about Dr. Peddle as well, you know, she's not trying to push me just to do VT.. She's not being like, hey, you've got the money, like just like spend it. Right. She's like, I think you're good enough at home that you can do this on your own. Which like how many people who own their own practice would say that?

Denise: Yes, but they, they are not dealing with you all the time. I mean you were in there learning all the stuff. So that's why you're like a junior vision therapist or maybe even a full-fledged vision therapist at this point.

Vance: Yeah. And so, I think what, what she mentioned now is just, you know, keep at the home VT and let's see if that latent deviation is going to reduce or if not we'll you know, go from three-month check-ins to a six-month and just go from there. But like I said, the engineer in me really wants to knock out that, that five and. Cause then he's not trying to keep alignment. It's just so natural. That. Yeah. Makes everything much easier.

Denise: Right. Well, I think that there's probably a good chance that you'll be able to get there, as you just keep it being part of your natural process. We don't know. Right. But even if it didn't resolve completely, he'll know what to do.

Vance: Yeah. And I think what I'm excited about is, what really was telling was at three and at four he doesn't know what eye control is. He doesn't know why he needs to keep his eyes straight. You can explain it, they don't know. But the fact he was doing it at three to four shows me that when he gets to maybe like eight, nine, at that point he knows when that eye is shutting off and how to turn it back on. So just like building that muscle memory of oh, I lost my right field of view. Okay, I know. Because, it's funny when he does have a turn now, like let's say on the Friday evenings, I'd actually be like, straighten up. And he can move that eye independently almost and straighten it up. So, I think as he grows older and more mature, that control is just going to be so much more innate in his ability.

Denise: Right. Well, and then as he learns techniques for relaxation. And I think relaxation is the thing, honestly, because that's what I find is the thing for me. If I'm feeling the tension in my eyes and the tendency for my eye to just want to wander a little bit, I just have to consciously say, okay, breathe. Look at your periphery. You know, relax out. Or I'll palm. You know, just to get the relaxation part so that the eyes can say, oh, it's not fight or flight. I don't have to be concerned. I can just see, right?

Vance:  Yeah. And I wonder, like, how much of a battle that was for him initially, because his eye, I think when his strabismus first showed up when he was two-and-a-half, his brain had just developed this trick for suppression. Right. It's like, I'm seeing double. I'm seeing blur. Like, I just can't do this anymore. I'm just gonna. And then it learned this trick that maybe it was not supposed to learn to just turn that eye off. Right. And so just to almost like, re. Acquaint the brain with, hey, we're in a safe space where it's okay to see double. It's okay to see and blur and then fight through it. Yeah. I just. I always wonder from his perspective, and I'll never know his perspective because he was so small, but it's something. I always wonder, like, what was he seeing? What did he experience? What innately in his brain was he fighting? And so.

Denise: Yeah. Yeah, well. And you mentioned that your other two children don't have a vision issue.

Vance: No, no. And we got them checked out. And it was kind of funny because I spent. I'll give you a bit of a backstory, but when we started vision therapy, like in session 10, the vision therapist gave us this rand dot exercise for the computer. And, you know, she said if he can see this, he can see in 3D, but it might not come. She's like, just do it once a week to see if it happens. Right? And I would do it once a week with him every day. And it's basically a circle inside of a big circle, and it moves, and you can see either it's left, right, up, or down. And for a year and a half, he's like, I don't see any small circle in there. And, you know, I wouldn't get disappointed. I think as an adult, if I was doing it, I'd get very frustrated, like, “why can't I see it?” But he, as a three-year-old, didn't care. He's like, I can't see it. And I remember after a year and a half, I'm just doing it as part of my weekly exercise with him. And he's like, “left.” I'm like, “okay.” And I was like, what's the next one? He's like, “right.” I was like, “yeah, that's correct again.” And then he keeps going up, down, and everything's just perfect. I'm like, oh, my God, you can see it. And I, like, cried that day. I mean, it's so silly because it's just you. But we've been doing this for a year and a half, right. And then when my daughter was born, I think at around like two years old, I did it with her and she saw it immediately. Day one, she was just like, “left.” I was like, “okay.” And she got to a really high level of stereopsis with base in and base out. And it was, it. It just surprising to me how it can come so easily to like, let's say 95% of people who don't have strength, but for that 5, it's like you're spending years trying to get what someone was born with, maybe, Right?

Denise: Yeah. Well. And a lot of those 5% don't realize that they don't see like everyone else either.

Vance: Yeah. Like, are they seeing depth? Are they seeing color? And. And I think after I leave this earth and go to heaven or whatever, I really want to know, like, hey, can I go to Lucas Body when he was like three and just see what he was seeing? Like, what was it? Like, that would just be my dream to experience what he experienced.

Denise: Yeah. Well, you might not like it very much.

Vance: Yeah.

Denise: And I think the other thing people wonder about is what causes it, you know, and we were talking about the fact that he was premature and. And a lot of trauma surrounding his birth. Right? Do you attribute that to the vision issue?

Vance: 100%. I think it's the. The combination of things. So, it's not that, you know, every premature baby's gonna have this, not that every cesarean is gonna have this. I think the fact that, you know, he was a low-birth-weight cesarean in breach, so being upside down, I think all those things combined, maybe the eye, like, wasn't fully set in place when it came out. Maybe there was trauma and so it was seeing double and, you know, the shaky vision and overcame it. But then when he was two and a half and wants to focus because two-and-a-half is really the time you see it manifest, because that's when they want to see the detail. They don't want the blur. They're like, I don't want to see blurry text or blurry objects. I want to see that perfectly. Right? So, I definitely think. Because my two daughters born after that were born at term, vaginal delivery, not breech. So, the fact that, you know, genetically everyone's the same over here, but it had to be one of the things with the birth that caused it. I don't know for sure. I don't think I'll ever know. But, you know, for the longest time, I would wonder, was it a fall at a playground? You know, I remember once when he was on the. The swing, like, he fell off the swing. I was like, was that what caused it? But then I went through all of the pictures, like, obviously, the thousands of pictures you take when your baby's born. And I think right around two months, I saw one picture, one picture with that eye turned in. And it's funny, because when I took that picture, I didn't think anything of it, because babies, you just don't notice it. But I saw that picture, and I was like, okay, I. It was almost like I could relax, that it wasn't something I did. It wasn't like a fall. It wasn't the food he ate. It wasn't.

Denise: Yes, yes, I totally get it. You know, I had Patricia Lemer on my podcast a while back, and she talks about the total load. All of the things that combine to create whatever issue the child has. Right? Whether it's autism, whether it's strabismus, or any of those other things that, you know, we deal with. And she just came out with a new book on the total load that she. She applies it to learning disabilities and vision and everything else. Right. And so, I think that you could look at it from that standpoint, too. Right? Yeah, all of those things just kind of combine. But I like to connect it back to birth, too. And I recently was thinking about that with relation to my daughter. And you probably remember when I talked to my daughter about hers, and we didn't talk about her birth at all. And so, I was just thinking about it recently, and I thought, you know, when she was born, she came out with a really enlarged umbilical cord that. And my midwife that had been delivering babies for 40 years had never seen anything like it. And she had me take her to the doctor right away. So, you know, I just had her at home. I'm taking her to the doctor that day. They look at her and they're like, she's fine, but we don't know why her umbilical is so big, you know. And they decided that there had been some trauma to the umbilical cord in utero during the pregnancy, and it had repaired itself. Right. And I had fallen when I was six months pregnant and broken my ribs. Like, it was a really bad fall, and it must have damaged the umbilical cord. Right. And so, I just started thinking about, okay, that that had to have been traumatic to that fetus. Right.

Vance: Yes.

Denise: And we just don't even know how all of these things combine. And, you know, we end up with a child with the same problem. You know, like, she's my only one that has the same problem as me.

Vance: Yeah. And I think it's important to realize that a lot of things can cause this condition. And, you know, for the longest time, in the first maybe six months, I was just like, what caused this? What did I do? I don't know. I think as an engineer, again, I was like, what did I do? What did I miss? Did I not do a certain game when he was three months old that I was supposed to then you want to, like, be. Babies have been born for thousands of years and.

Denise: Yep.

Vance: not had all the toys and tummy time that we do. Right? So. and Dr. Peddle had actually asked us in that first October visit, how was Luca's birth? I think that was one of the questions, because in the notes, I have all the notes from every appointment, it's written there. Born at these many weeks, born cesarean, I think, because that feeds into her VT that she organizes, because we did a lot of those body movements, you know, the snow, the snow angels, the lifting your legs up one at a time. Um, and it's kind of interesting because a lot of those movements he was not able to do for, like, a year. Like, crossing, like, in and walking like a penguin or like a pigeon or doing the snow angels symmetrically. But my daughters, I always love comparing, because you can see how a child without strabismus does everything really fast and pretty much perfect synchronization.

Denise: Yeah.

Vance: And so just catching him up with all of those things was just. It's just enlightening because for me, like, vision therapy has gone far beyond the eyes now. It's the body. It's our relationship together. Like, one of the first things that she mentioned as well was no screen time at the first appointment. And luckily, we were a no screen time family before that as well. But she said zero screen time, and we've kept zero screen time till now. It's just part of who we've become organically. Like, obviously, now we can look at a screen without an icon, but we just have changed fundamentally as a family. Because of strabismus, because of vision therapy.

Denise: Yeah. I'm glad that you brought that out, too. I think that's a key component, and people ignore that part of things a lot of times.

Vance: Yeah.

Denise: And that's powerful.

Vance: I think there was one, again, not to compare or judge, but there was one parent who was bringing their child in for vision therapy, and I think they were there five minutes early or 10 minutes early, and they gave their kid a phone. And the kids playing a game on the phone with an eye turn. I always like to use analogies, but it's like trying to teach your child to ride a bike on a mountain going downhill. Like, giving them a phone. It's just the most visually taxing activity you can give them when their world is completely shaking going in and out. So, you gotta go very slowly. And I think it took us a year and a half to introduce. We gave Luca a small camera with games on it. It took me a year and a half to get him there to play the games on that, because he's eventually gonna be exposed to it. So, he's gotta learn, right? Yeah. A year and a half.

Denise: Wow. That is amazing. I just love your story so much. I think it's going to be really powerful for people to hear it and understand that. We talk about how big of a commitment it is to do this, but it really pays off, right? We make the big commitment, and then we get the result. And it's worth every bit of it, right?

Vance: A hundred percent. And even, like, going into the vision therapy office, like, that's. I mean, not that it matters, but that's saving us money right now because I learned so much of what to do that now if Lucas says, hey, this is blurry, or, like, this is kind of going in and out, I know exactly what tool to bring, what flipper to bring out, what activity to use to kind of help him get through that. And you start to realize, like, at this point, I know a hundred percent it's all in his brain. Like, his brain has these neural pathways where if it's very excited for things like food, his eye will turn in because he wants to see it. So now we’re teaching him, like, hey, it's just food, just like casually look at it. 

So, you realize that surgery sometimes is not the right answer. Like, it's the brain's way of, you know, he's an extremely intense person, more than me, which is a bad thing, maybe. But, you know, and so it's kind of like regulating that intensity and being like, hey, we don't need to over focus because you're excited about seeing something awesome.

Denise: Yeah. So, I think we probably covered what we wanted to with your story. Right. Do you have some. Some last words of wisdom for our listeners today?

Vance: Yeah. So, I've met a lot of parents who, you know, are seeing this icon for the first time. I mean, it's surprising because you think it's 5%, and maybe it's because we have a lot of kids in our area, but we've already met, like, three people that are going through this journey, right? So maybe what I'll end with is telling you kind of what to do if you see that eye turn. So, first, if you see an eye, like one eye go in or out, it's not your kid being funny or trying a new trick. Like, no person is able to move their eyes independently. So, I mean, if both eyes are going in, maybe they're crossing it intentionally. But if one eye is going in or out, like, it's most likely strabismus, I think definitely look for a developmental optometrist. And, you know, if you can't find one, like, talk to Melissa Daniels. She goes and looks in your area and tries to find one. Book an appointment with her. And when you find one, make sure the optometrist is doing that cover test. Make sure they're mentioning strabismus or amblyopia or esotropia or exotropia. Make sure they're checking for stereopsis and that the child can see in 3D. And then make sure that they have a vision therapist in office. I see a lot of ones that are online and ones that they'll do it over Zoom. In my opinion, that's a hundred percent not gonna work, because when Lucas, vision therapist is there, she is up in his face, like, covering things, moving things in and out. You need to be, like, in person. It's not gonna work online. If you can. If there's no one in your area. Maybe online's better than nothing, but try to get someone in person, even if you have to drive like an hour or two. And then I'll just say keep the commitment. Like, try to do the 30 or 40 sessions. I don't. In some cases, you know, 10 might work, but I think in most, it's going to be 30 or 40. That's the sweet spot. And, yeah, I think it's the financial commitment. Like, I know it's easier said than done but try not to let that be a limiting factor, because you're eventually going to need it, so. And it's going to be much more expensive, much harder in the future. So, try to just do everything as you can now.

Denise: I love it. Great. Yeah. And I'll just add one thing, because I think there are various levels of difficulty in whatever the situation is. Right. And for my own daughter, I think we might have only had about 20 sessions. I think it was only about nine months. Right. And so. And she was nine. So, there's going to be a lot of variation, and it just depends on the child. Right. And if it's, like, conversions, insufficiency, that usually takes less time, you know, if it's your situation or something that's even more difficult than, you know, how Luca's eyes were, then it may take longer than that. But everyone is just so individual. And did you just have to be making that commitment? Right.

Vance: Yeah. I think the fact that he was younger, like three, like, maybe the first 10 to 20 sessions were kind of base-lining him and trying to get him to participate. Well, yeah. I mean, I remember in the first session, I was like, this is gonna be 10 sessions, and we're gonna be done. He's gonna be perfect at the end of it. But I think it's just a journey, and we're still on that journey. And so maybe I'll come back in, like, a year and be like, we got rid of that five to eight diopter deviation that's latent. But right now, he's, like, functionally cured, which is good. Like, he's. His eyes line up 95% of the time, and in the five, he is able to snap it even when it turns. So.

Denise: Yeah.

Vance: Just very happy with the results so far.

Denise: Yeah, it's awesome. Well, thank you so much for sharing your story today.

Vance: Thank you for having me.

Denise: Yeah. Hopefully we'll have some more people that hear this, and then they go through their journey and then they come and share it, too.

Vance: I would love that. Because honestly. And I would just love more people to know about it so that if they see it… you know, there was this one time I was at a restaurant, and the kid had an eye patch on him, and I just wanted to go there and be like, that's not going to work. A hundred percent. Not going to work. Like you use a translucent eye patch just for VT, but you should not be wearing it 24/7. That's not going to strengthen the eye. So just things like that. I wish people knew more so they see it. They're able to help wherever they can.

Denise: Yeah, yeah. That's my wish as well and I put it out there every chance I get. So, thank you for adding to the dialogue.

Vance: It's great. Thank you so much for having me, Denise.

Denise: You're welcome. Thanks for listening to the Healing Our Sight podcast today. I'd love to connect with you. You can leave a comment by clicking the link in the show notes. I love receiving your messages. You're also invited to join the Healing Our Sight Facebook group. Let me know what resonated with you and how I can better serve you.