Q&A
What does optometrist Dr. Jem Martin think about vision exam prep and CVI research?
Get to know our amazing provider: Dr. Jem Martin. In an interview, we discuss Dr. Martin's optometric background, how to prepare for vision exams, and where CVI research is headed.
At three and a half years old, my son Mason’s CVI diagnosis by Dr. Kran at the Low Vision Clinic at Perkins was life-changing.
Mason has also been seen by Dr. Ross at the New England College of Optometry’s (NECO) Pediatric Low Vision Clinic for the past two years. Our Low Vision Clinic appointments have always been incredibly thorough, and the expertise and care we’ve received has had a direct, positive impact on my son.
In addition, I want to spotlight the care we received from Dr. Jem Martin. Mason has had multiple appointments with Dr. Martin, both during their residency and after they accepted a position as an attending optometrist at NECO Center for Eye Care. We’ve found Dr. Martin to be a friendly and exceptionally perceptive provider.
So, I wanted to get to them a little better. Read our interview below to learn more about how Dr. Martin fell in love with optometry, what to expect during a low vision exam, and how our understanding of CVI is rapidly growing.
What initially sparked your interest in optometry? Can you describe how you “chose your path,” so to speak?
I have been going to the optometrist since I was in second grade and had the typical complaint of “I can’t see the board!” As someone with complex medical diagnoses as a child, the optometrist was one of the few doctor’s visits I enjoyed (and wasn’t getting poked at!).
What really solidified things for me was the children’s museum in New Orleans, which had a floor dedicated to vision. There was a hall of optical illusions, you could step into an eyeball model and learn about the structures, ways to experience vision of different animals, and a small exam lane for the kids to play in. It was always my favorite portion of the museum, and it took off from there.
When did you first learn about CVI?
My first exposure to CVI was a brief lecture at the end of my second year. It wasn’t until my third year that it was brought up again in more of my lectures, including Low Vision and Pediatrics courses. During this time I was also a third-year intern at Perkins with Dr. Kran. Seeing the patients in person and experiencing the myriad of presentations as well as difficulties faced by this population piqued my interest, and I was determined to learn more about a condition that still isn’t fully understood even within the optometric world.
What are your research interests?
Much of my research so far has been around CVI, specifically the diagnosis and impact of intervention after diagnosis. I have been working on validating one of the commonly used surveys used to help supplement the history taken with the patient and parents. Beyond CVI, I also have an interest in other brain-based visual impairments, such as hemianopia, which is a visual field loss in each eye on the same side, often after a stroke or traumatic brain injury.
How does a visit to the NECO Pediatric Low Vision Clinic or the Perkins Low Vision Clinic differ from a typical visit to someone’s local “eye doctor” or even a pediatric ophthalmologist?
There are several elements that are the same – gathering visual acuity (“20/20 number”), side vision, and glasses prescription determination. Then we take it a step forward and also look at visual function – contrast, or how bold something needs to be, visually guided movement and eye-hand coordination, as well as the effect of complexity and novelty on visual function.
One of my favorite parts is getting to play with puzzles with the kids. It provides a great rest break from having to do some of the more invasive testing, as well as provides information on how the patient perceives the world based on their approach to placement of the puzzle pieces and how they handle increasingly complex tasks.
Is there anything parents can do to prepare for these visits, and to help ensure that they go smoothly?
Prior to examinations, we often ask the parents to send in previous eye and medical records, as well as educational evaluations, to help us set the stage for the examination and have an idea of the patient’s, family’s, and team’s concerns.
On the day of the examination, we encourage parents to bring familiar items or toys as well to help the child acclimate to the new clinic environment with something that is familiar. We may also use the toy or other objects from home to help demonstrate testing, or to evaluate visual function with the object.
We hear a lot about parents and patients having to fight for a diagnosis, and then fight for services. For a moment, let’s focus on the positive, rather than the fight. What’s going well in terms of diagnosing CVI and helping to serve patients who have CVI?
Even in the last few years since I learned of CVI, I have seen leaps and bounds as far as research in the field goes. I recall as a student having difficulty finding reputable research to look to simply because the body of knowledge is still growing. Now I find that I am able to find several papers not only on etiology, but examination techniques and intervention recommendations as well.
This in turn is expanding the knowledge of cerebral visual impairment to optometrists who do not work in specialized pediatric/low vision clinics. While they may not have the confidence to fully evaluate and make the diagnosis, the increased recognition of CVI presentations can lead to capturing more who may be affected by it, and then are able to receive an appropriate referral to get the diagnosis.
Can you briefly explain kinetic perimetry?
For context, we assumed for years that Mason had some field loss, but couldn’t “prove” it. He quickly learned to anticipate the penlight in more informal field testing, and static perimetry yielded normal for age results. Kinetic perimetry, as you know, revealed that Mason has a significant lower field loss.
When testing visual field, we often have either static or kinetic perimetry. Static perimetry is where there is no movement of the target. For adults who have done a side vision test, this is when you look at a target in a bowl and click a button when the light appears to the side. Kinetic perimetry involves movement and can be done a number of different ways, be it in a bowl with moving lights, or in free space with wiggling fingers.
As many may know, movement in CVI can either be a positive or negative. Some may find the movement allows them to catch the moving object further out when compared to a still light turning on and off. Others may actually find the movement to be inducing too much clutter and movement, and can result in a constricted field.
Having a number of different ways to approach and test side vision is helpful as we can see the differences that approaches and environment can affect findings, and use that to help discuss the functional implications with caregivers and other team members.
What’s the best part of your job?
100% the patients.
Every day I get to see so many different people of so many different experiences and we get to laugh and play and, most importantly, work on adaptations to increase their access to their world.
Does your child ever get nervous about visiting the eye doctor? Before your next appointment, use our six-step guide, created by Mason and his mom, Kira. Plan out your trip, and soothe anxieties!
- Download or print: A Visit to the Low Vision Clinic
