Before we welcomed Angela into our home we were told about her many diagnosis -- well, actually we learned about quite a few after placement but that's a whole different post. One of her challenges we did know about was that fact that she was considered cortically blind. When Angela was born she suffered a grade IV brain bleed due to her prematurity and also from her overall fragile state due to sepsis. The hemorrhage was located in the front of her brain directly surrounding her optic nerves. On exam you can see that both her optic nerves are very pale -- meaning that at some point, which we know was the point of brain injury, the optic nerves did not an are not getting the O2 they need. So this makes Angela have visual impairments. There is noting drastically wrong with her actually eyes -- it a brain issue as her brain is unable to comprehend what her eyes are viewing.
With this said -- Angela's eyes are healing. When she first came to us over six months ago I would have said with full confidence that Angela was blind, with the exception of her ability to see bright lights. She did not focus her eyes and only occasionally would appear to be seeing something. She is totally different now. She is using her eyes more and more to look at faces and objects and can even aim and grab objects such as toys at the table on on her toy gym. Stimulation, lots of love and a whole lot of God's provision does amazing things!
Since we knew that she could see we needed to find a way to learn exactly what she could see so that we could better push her to her full potential. We learned about the low vision clinic at the Eye Institute of Philadelphia and immediately knew it was a perfect match for our family. The eye exam is specifically designed for children and adults who are not able to do a traditional eye exam. The exam is very intense and looks both at past history and also took into consideration a lot of what I as her mother thought about her vision. The exam took about two and a half hours, and although it was a long visit Angela did amazing and they kept her engaged the entire exam.
Through the use of specialized tests we were able to figure out what stroke width Angela is able to see -- meaning if she were reading -- what font size she would be able to read. One of the coolest things I got out of this entire exam was that fact that the doctor said to me, "When Angela reads you will need to make sure the print is enlarged to this font size." Did you catch that? She said, when she reads. Amazing. I loved that she saw Angela for the intelligent little girl we know she is. We were also able to determine a little about her field of view. It appeared that she is limited on her left peripheral, but they were not confident to say she has no vision in this area as Angela was pretty tired at that point. They were able to say that her right side is very strong so for education purposes things need to be presented to her right field of view and for therapeutic reasons we should encourage her to look to her left field of view. We will be going back next month to explore her vision even more including looking at color preference and depth perception.
Does your brain hurt yet?
We left with a prescription for glasses since she also has a significant astigmatism and is also mildly near sided. I left with confirmation that Angela sees more than what she often shows the world she can see. I left with excitement -- excitement of possibilities and hope for Angela.
Not that I really needed confirmation that she is fabulous -- but it always helps!