11yr old doesn't see every other letter

My mother took my little sister in to get an eye exam thinking she needed glasses. She's 11 years old and is a little slower in school than most kids when it comes to reading and math. Most of the time she will reverse or put upside down letters. We're assuming some sort of dyslexia. At the exam, when reading the chart she told them every other letter. When asked if she saw something between the letters she said there was a small fuzzy spot. One of her eyes is 20/70 and I don't remember the other. When my mom asked the doctor if she needed glasses for the skipping problem he said he has no idea and definitely doesn't think glasses will be the cure. He's sending her to a pediatric doctor.

I'm not asking to get a miracle answer, I'm just wondering if there is a doctor that can tell me they've seen this before.

[mooduk]

It sounds like your sister might have a severe tracking problem.  I've found that the best profession to evaluate this sort of ailment is not an ophthalmologist (no offense!!) but a neurologist or a neuro-ophthalmologist.  The neurologist must be one who specializes in neurological diseases that affect vision, like Alzheimer's.  Most pediatric neurologists specialize in seizure control and may or may not pick up visual/neurological difficulties.  I've heard there's a neuro-ophthalmologist at Johns Hopkins who specializes in eye movement disorders so if you're close to Maryland, that might be an option.  I only know this because our daughter has aspects of Balint's syndrome.  That causes a form of simultanagnosia (ability to see only one thing at a time) and ocular apraxia (inability to move eyes from one thing to the next).  She has intermittent episodes of ataxia (inability to guide hands and feet to a visual target) as well.  Her acuity (ability to see the eye chart) is normal.  Only her alternating, intermittent esotropia (eyes turning in) is usually attended to during a normal pediatric ophthalmology exam.  Her neurologist covers her neurologically based visual impairment (CVI).  Our daughter is an academic student who uses large print, computers and has a lot of trouble with visual-spatial math skills.  She needs to learn math as if she is blind.  Mooduk

[John C Hagan III, MD, FACS, FAAO]

To TEGKelley   I don't agree with mooduk and feel you do not need to start a "million dollar work-up".  The place to go is to a pediatric ophthalmologist. Nor is the observation hard to explain. The 20/70 eye is most likely amblyopic.  Amblyopic eyes exhibit the "crowding phenomenum" which is just like you stated every other letter is fuzzy. A test for amblyopia is to have a child read single letters. The child may be able to read 20/30 with single letters but only 20/70 due to "crowding".

JCH III MD

[mooduk]

Wow.  Thank you fo ryour response.  We've only run into one ophthalmologist who understood the crowding effect.  Our daughter did not receive her first bifocals, which was her first visual aide, until age 6.  And that only happened because I knew enough at that point to ask for dynamic retinoscopy.  One ophthalmologist said suspsected CVI, the next said nothing wrong, not even glasses needed, the next prescribed bifocals.  It was VERY confusing!!  Early intervention would have helped our daughter a lot, but we tried.  We kept running up against the wall of normal acuity.  It seems that normal acuity automatically means that most ophthalmologists think vision is fine.  I now know there is a lot more to vision than just normal acuity, and a lot of it happens in the brain and not the eye (if that makes sense).  Mooduk

[John C Hagan III, MD, FACS, FAAO]

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