They first met on September 29, 2018, 3 weeks after Matt moved home. Several years later, Dr. Kushner would share these recollections.

“When I first met Matthew, he could only communicate with yes or no.  He was having difficulty reading.  Matthew presented with a right homonymous hemianopsia. This severely impacted many aspects of his basic daily living and ambulation, making it difficult to navigate safely. In addition, Matthew had convergence insufficiency, which is difficulty crossing the eyes inward as is needed when doing close work tasks.  This also makes it difficult to read, either causing double vision or fatigue from the effort required to overcome it.  His prognosis was guarded.”

Dr. Kushner was very creative in identifying visual symbols that Matt was able to recognize in order to perform a rudimentary eye exam. For example, he held three fingers up sideways to resemble a capital E and had Matt point in which direction the letter was pointing. He asked Matt to follow a moving object from side to side or as it moved towards (convergence) and away from his nose (divergence). Preliminary findings highlighted limited right peripheral vision and poor eye convergence.

As time progressed, more problems came to light. Fortunately, Mike has specialized training in vision therapy, which proved instrumental in addressing this aspect of Matt's recovery. He helped me understand the significance of four issues that compromised the ability of his eyes to work together. For example, strabismus, an abnormal alignment of the eyes, caused Matt’s right eye to deviate to the right. In addition, his eyes often overshot a target, a function known as smooth pursuit, and rapid, jerky eye movements known as saccadic movements impeded his ability to focus on a target quickly. These issues, combined with his convergence insufficiency, led to a profound lack of spatial awareness—the ability to understand his body's position in relation to his surroundings.

The end of each visit focused on presenting and practicing the next round of home exercises. To optimize recovery, 20-30 minutes of daily home exercises was the requested intensity. We always left with two to three new sets of instructions to add to our growing collection.

Convergence training at home involved a string with three to five colored beads, spaced at different intervals (Brock String). Matt held one end to his nose, and someone else had the opposite end three to four feet away. He was asked to look from one colored bead to another while maintaining awareness of the position of the string and other beads.

For spatial awareness, Matt pointed and touched objects in front of him with his hands. He also practiced a beanbag toss, sitting or standing, using buckets as targets. This simple task challenged his physical balance, spatial awareness, and vision all at once. Standing independently and throwing beanbags into buckets six to seven feet away was particularly difficult given his poor balance. While one-handed throws weren't too bad, he consistently missed the bucket on the right when throwing with both hands simultaneously. We couldn't resist groaning and laughing, especially when a bean bag barely made it halfway or missed a bucket by a mile. Engaging in therapy outside on the deck, such as this activity, offered a welcome change and a breath of fresh air.

To retrain smooth pursuit and saccadic movement, Popsicle sticks with a letter or number written at the top were used. In the first case, without moving his head, Matt moved a single stick side to side, up and down, diagonally, or in a circular pattern, and followed it with his eyes. For the next phase, Matt held two Popsicle sticks at arm’s length and moved his eyes as instructed in similar patterns. His right eye often lagged behind his left, or went completely rogue.

To expand his right peripheral visual field, Matt had to focus on an object straight ahead while Mike tossed a beanbag from either the right or left side. Matt was supposed to catch it as it flew by. He'd deny it, but he often cheated by trying to catch a quick peek. If it had been a betting game, I would have wagered on a high percentage of missed catches when the beanbag was tossed from the right.

After a three-and-a-half-year span, and four or five rounds of treatments, we parted ways. Dr. Kushner shared his final reflections on Matt's journey with profound insight. “As much as Matthew must have been frustrated, he has an incredible work ethic and sense of humor.  He was all too happy to play tricks on me!  His parents moved mountains to get him the help he needed and pushed him to move forward.  They worked incredibly well as a team.  The amount of progress that Matthew has made has been astounding.  He no longer has Convergence Insufficiency.  His field loss persists; however, it is smaller.  It’s more of a quadrant anopsia rather than a hemianopsia.  He has learned to compensate for it by moving his head to be more aware of his surroundings.  Matthew really has beaten the odds.” 

“Guarded prognosis?  Boy, was I wrong.  His prognosis is limitless.”

© 2025, Sarah Watkins