President Abraham Lincoln: A great man with a drifting eye

Photo of President Abraham LincolnPresident Abraham Lincoln had a rugged, somewhat homely look. Now scientists say that Lincoln’s face, which it’s said was often the brunt of ridicule, was distorted due to a medical condition called cranial facial microsomia. The result was that the left side of his face, including the eye socket, was much smaller than the right.

According to Dr. Ronald Fishman, an Ophthalmologist who led a study published in the August issue of the Archives of Ophthalmology, “Lincoln’s contemporaries noted his left eye at times drifted upward independently of his right eye.” Fishman also said that, “Lincoln noticed double vision only occasionally and it did not bother him a great deal.” The strabismus is thought to have been caused by a displaced eye muscle related to the smaller left eye socket.

Lincoln was kicked in the head by a horse when he was young, but it is not known if his facial disfigurment and strabismus were caused by that trauma, or if they were a developmental defect.

What we do know is that history tells us that our 16th president, Abraham Lincoln, was one of the most loved American presidents; yet he had a drifting eye, a misshapen face, and no formal education. Lincoln was not without his opponents. In fact opposition led to his assassination at the age of 56. But history remembers him as the president who led our country through the Civil War, stood tall against slavery, and firmly upheld that “all men are created equal;” yet was a humble man who did not consider himself better than the people he served.

Abraham Lincoln (Feb. 12, 1809 – Apr. 15, 1865) was the 16th president of the United States of America.

Lincoln’s Craniofacial Microsomia, Ronald S. Fishman, MD, Archives of Ophthalmology, August 2007.

Abraham Lincoln, Wikipedia.

Scientists on Abraham Lincoln’s Face Defect, Science QJ Net.

Photo credit: Apples 4 the Teacher

Vision Impairment definition: What about Strabismus?

Traditional Snellen eye chartIt’s pretty easy to define Vision Impairment. Just grab your dictionary and look up the words “vision” and “impair.”
Vision: The act or power of sensing with the eyes; sight.
Impair: To make or cause to become worse; diminish in ability, value, excellence, etc.; weaken or damage.

Permit me to offer my simple definition of Vision Impairment, based upon our defining source, the dictionary:

Vision Impairment is a state in which the act or power of sensing with the eyes (sight) is worse than optimal; diminished in ability, value, or excellence, etc.; weakened or damaged.

According to the World Health Organization, as quoted in the U.S. Government’s Agency for Healthcare Research and Quality, to have even a moderate vision impairment a person’s best corrected visual acuity must be less (worse) than 20/60. This 20/60 standard has been, and still is to a large degree, the defining standard for most of the U.S. Government’s publications and mandates.

The U.S. Government Centers for Disease Control and Prevention (CDC) starts it’s What is vision impairment? item a little more reasonably:

Vision impairment means that a person’s eyesight cannot be corrected to a “normal” level. Vision impairment may be caused by a loss of visual acuity, where the eye does not see objects as clearly as usual. It may also be caused by a loss of visual field, where the eye cannot see as wide an area as usual without moving the eyes or turning the head.

The CDC’s item goes on to cite the definitions offered by WHO and mentions the U.S.’s category of legal blindness, then continues to add a slightly more comprehensive view of visual acuity:

Visual acuity alone cannot tell you how much a person’s life will be affected by their vision loss. It is important to also assess how well a person uses the vision they have. Two people may have the same visual acuity, but one may be able to use his or her vision better to do everyday tasks.

I felt the CDC’s item was vague, but it is improved from the standards of strict adherence to 20/60 being the only criteria for Vision Impairment.

The American Academy of Ophthalmology adheres to the WHO’s 20/60 definition of Vision Impairment, but it does, thankfully, offer some concessions for other vision problems as well: According to the AAO, the definition of vision impairment is this: “If your vision with eyeglasses or corrective lenses is 20/60 or worse, you are considered visually impaired. Limitation of side vision, abnormal color vision, or presence of double vision in one eye also may determine visual impairment.”

The Optometrists Network goes much further, defining Vision Impairment to include Binocular Vision Impairment caused by Strabismus. Here is what The Optometrists Network says: Continue reading Vision Impairment definition: What about Strabismus?

Finding help for the children

boy walking through fieldA reader named Carol writes:

This has been very frustrating for my son-he has Intermittent Exptropia- we have tried COVD, UCLA, you name it and Yes he has a visionproblem-but everyone wants $$$$$ A good 5,000 – 10,000 We are not rich, what gets me thought is that if I were divorced form my husband-we could be LOW INCOME and VSP would step in the public schools would step in – but of course he has been diagnosed per the shcools as ADD/ADHD-its easier to pop apill then see the real problem, this also has effected the way the is treated in shcool being labeled-now all we have is a frustrated son whom feels hatred and disgusted!!

It breaks my heart that your child is not getting help for his exotropia. My diagnosis is intermittent exotropia as well. I don’t want to see any child go through life, as I did, without receiving help with their strabismus.

Carol, please don’t give up. There is great push among eye specialists to work toward ensuring that children with vision problems can receive help. New legislation continues to be introduced, and laws are changing in many areas.

Here are some ideas:

  • Last month, I did a write-up on P.A.V.E. Check their website to see if there is a local chapter in your area, and if so, ask if they are aware of how you may get help.
  • Join a support group. You can find a number of support groups at Yahoo Groups, including our new Eyes Apart Strabismus Support.

Perhaps others will offer suggestions of help for your son in the comments area. Please check back often.

[Groups updated 10-23-06]

Photo Credit: Janet Goulden

P.A.V.E. — Parents Active for Vision Education

P.A.V.E. logoThe P.A.V.E. website says: “P.A.V.E. is a national non-profit education, resource and support organization whose mission is to raise public awareness of the crucial relationship between vision and achievement.”

I’ll be turning 60 this year, and I’m only now beginning to understand some of the reasons I struggled to keep up much of my life. I’m not sure I would have made it through school, and especially nursing school, had I not found books so fascinating. Though it was an effort to keep my eyes focused, I loved the treasures I found inside, and it was worth the effort to explore their pages.

But it became harder and harder to read as I got older. Although I was diagnosed with intermittent exotropia at age nine, most eye specialists I saw simply treated the problem with a new eyeglasses prescription when I complained of struggles to read.

A couple years ago, as my ability to stay focused became critical, I was being evaluated for Alzheimer’s, ADD, or Learning Disability. See my June 22, 2005 post: Is this all in my mind?. Before my testing could be completed, however, my inability to focus my eyes became so bad that it was obvious my problem was related to my strabismus. It took several decades for my vision to get to such a critical point that left little doubt about the root of my struggles.

I often think how my life could have been different if organizations like P.A.V.E. and others who support Behavioral Optometry had been around back then. But my life is different in a different way now, and that’s not all bad! Now I’ve seen first hand how strabismus can masquarade as other problems and worsen with age if not treated. I have a unique opportunity to help educate others about the importance of early vision screening and treatment.

There is no reason now for anyone to have to go through life with untreated strabismus as I did. Help is available today. I’m thankful for organizations like P.A.V.E. that are educating the public about that help.

‘The Eye Patch Kids’ DVD

Eye patch kids dvdA few weeks ago I wrote about a DVD called ‘The Eye Patch Kids’. Since then, my 7 year old grandson and I have had a chance to watch the DVD together several times. It’s full of humor that appeals to a child. My grandson laughs all the way through it!

The story is about Princess who visits her eye doctor and is told she will need to wear an eye patch. She is reluctant to wear a patch, but her friends tell her what fun they have choosing and decorating an eye patch to fit their unique style. They show her all the things they can do with their eye patches on. Soon Princess is enjoying wearing her patch also.

“The Eye Patch Kids” DVD is available online at Bjort & Company, Inc. Photo above is (c.) Bjort & Company, Inc., used by permission.