Wednesday, June 13, 2012

Visual Evoked Potential

Visual Evoked Potential. It was the word potential that gave me hope. VEP is a kind of EEG. It involves fewer probes and  focuses on the back of the head, on the vision center of the brain. Also the site of Jasper’s stroke.

The pediatric opthalmologist at Seattle Children’s - not our regular eye doctor - recommended Jasper have a VEP prior to strabismus surgery. Results would show the strength of Jasper’s visual pathway, is it an open or a closed circuit? It could also help determine, is strabismus surgery a good idea? Would it be effective, would it take?

Jasper’s vision is inconsistent. Sometimes, he seems Ok. He sees his toys, he doesn’t run into walls, he imitates my facial expressions. Other times, he struggles. He searches for me against a complicated background, his tracking doesn’t match the velocity of objects, he looks at lights too much. In spite of his visual inconsistencies, I had high hopes for strong signals, sufficient activity, a closed loop. At the recommendation of both Jasper’s regular ophthalmologist, and our former vision therapist, I had decided on surgery regardless of VEP results. Because, as our regular doctor told us, “it is worth doing,” to give Jasper’s vision the best chance. After our VEP attempt in February, I didn’t expect Jasper to tolerate the test. Jasper’s cooperation yesterday was a blessing and a curse. Because I had hope - because I can see that Jasper can see - I didn’t expect a poor result.

The Children’s ophthalmologist is one of the top pediatric opthalmologists in the world. He is notorious among parents for his crude bedside manner, his tactless nature, his harsh choice of words. He was an hour late for our 1 p.m. appointment. The exam room was dim. He showed me a printed out graph of Jasper’s results. There were two graphs, each representing a different pattern that was displayed on a screen during the test. The first test was pretty flat, and the esteemed doctor dismissed it. The second graph was a little more lively, but nowhere near the spikiness a typical kid has. I swallowed hard. And breathed. I wanted to cry. But didn’t. Jasper’s result showed low activity, a pretty open loop. As the doctor talked - this man who had diagnosed my nine day old newborn with cortical blindness - he continued to refer to Jasper as cortically blind. He could not recommend surgery, because it might not take. I told him I already knew that. He told me Jasper had “taken a hit.”

Yesterday was a hard day. It left me drained, sad, confused, questioning. Jasper’s results are not consistent with Jasper’s behavior, at least the doctor gave us that.

For the past month, I have agonized about sticking with our regular ophthalmologist, and having surgery done at Swedish First Hill. Or staying within my comfort zone, and having surgery done by Children’s ophthalmologist. Stick with our guy, who is optimistic, positive, hopeful, top notch. Or have it done at Children’s, by someone who has nothing good to say about Jasper’s vision. A doctor who has no hope for Jasper’s success.

Today was about recovery. I finally feel at ease with my decision. Jasper will have strabismus surgery at Swedish, with our regular guy. I look forward to a new environment.

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