I'm going to apologize in advance because I have a lot to say about this. I will try to keep focused, but there is a lot of crossover of issues and overlapping factors.
Four out of my 6 kids have been evaluated by a Behavioral Optometrist, including my 9 year old daughter with PANDAS. Three needed vision therapy, and 3 needed glasses, but not the same 3. In other words, there was 1 who only needed glasses, 1 who only needed VT, and 2 who needed both. Also, my husband is legally blind, has complete color blindness (sees no color), as well as other related eye conditions. He also had Lyme and saw an eye dr specializing in Lyme in the same office.
The appointments and the vision therapy were all covered by insurance. Here is the link to the doctor:
Office:
http://www.newenglandeye.org/
Doctor:
http://www.newenglandeye.org/our-locations/providers/richard-laudon/
Just to explain a little of what I've learned. A basic eye exam only measures visual acuity, written as a number compared to 20, such as 20/20 vision. This is what glasses help with. In a more comprehensive exam other things will be looked at such as the retina, optic nerves, eye pressure (very important for lyme patients), refractive error, and eye behavior (related to the eye muscles).
Refraction is basically how light rays hit the retina. Refracrive error measures if you are far sighted or near sighted, or just right with no "error."
Eye behavior is what is being talked about in this thread and what vision therapy helps with. The areas of eye behavior are convergence (eye teaming), accomodative behavior (eye focusing),and ocular motor behavior (eye tracking). They will also look for strabismus (eye turning) and amblyopia ("lazy" eye). So, the corresponding eye problems are convergence insufficiency (eye teaming problem), accomodative dysfunction (eye focusing problem), and ocular motor dysfunction (eye tracking problems). You can have one problem but not another. You can have all of them. You can have 20/20 vision (acuity) but have eye behavior problems. VT can help with acuity and the need for glasses, or just help the eye behavior.
I first found out about eye behavior and vision therapy when trying to get help for my now 13 year old son for school and behavior issues. This was long before we had Lyme Disease and PANDAS on our radar at home. My son has been a mystery over the years, and now, because of my daughter's PANDAS dx, I'm wondering if PANDAS could be an issue for him too. His is a long complicated story, but in a nutshell: colicky baby, sensory sensitive, significant visual issues (more on that later), learning disabilities, executive function disorder/ADD symptoms, panic attacks, anxiety, OCD symptoms, bipolar like behavior, rages, and I've even suspected tics. On an IEP since 4th grade now in 8th). After a neuropsych exam showed a much different profile than the school had always thought, and he fit the general pattern and profile of Twice Exceptional (giften with Learning Disabilities) but without technically meeting the IQ criteria, I suspected visual problems.
He ended up having *significant* visual problems. He has Anisometropia, sometimes called Refractive Amblyopia. Basically he has normal vision in one eye and moderate farsightedness in the other eye. Because he was not correcting his vision with glasses, and had never done vision therapy, his strong eye was taking over seeing for the weak eye. He was losing vision in the weak eye and is still at risk for eventually losing the ability to see in the weak eye. The condition causes him to also have significant convergence insufficiency, accomodative dysfunction, and amblyopia. Glasses do not fix the problem, and in a way make it harder to see because his strong eye is less able to take over completely and because the difference in prescription between the 2 eyes makes it difficult for the eyes to work together. He has been resisting vision therapy or even wearing his glasses.
If anyone is interested, I could explain a little about the "eye hygiene" and vision therapy and how it helps, but this is already really long so I won't unless there is interest.
What do other parents think about the possibility of my son also having PANDAS? On the one hand he has a lot of symptoms, we have a family history (my daughter has PANDAS, my grandfather had Rheumatic Fever, another son had scarlet fever, lots of anxiety and OCD, etc), he may be a strep carrier, etc. On the other hand I can't pinpoint an exact sudden onset of symptoms like I can with my daughter. It's almost like he was born with it. I did have strep while pregnant. Have there ever been any studies on exposure to strep in utero triggering PANDAS in infancy?