Stress-Related Focusing Problems

How did we get involved?

Professor Anna Horwood is also a clinical orthoptist at the Royal Berkshire Hospital and frequently sees children and young people referred for focusing problems from GP’s and optometrists. Professionals have been puzzled by many of these patients because their tests find no detectable eye disease – so working out how to treat these patients is hard. Sometimes treatment even seems to make things worse. They are sometimes termed “functional” problems or Medically Unexplained Symptoms (or even in past “hysterical”).  Now we know that the symptoms are very real, even if we can’t find a physical cause. The patients are NOT “making it up”!

At the Infant Vision Lab we have an objective method of recording what is going on, so we have been asked to see some of these patients. We are also based in the School of Psychology, which researches anxiety and depression in children and young people in the AnDY Research Clinic. Many of their clients suffer from a range of physical symptoms such as palpitations, tummy ache and odd aches and pains as part of their condition. During many seminars and conversations it became clear that the focusing problems seen in eye clinics could well be part of this spectrum, so we have worked with Dr Polly Waite to develop a psychological strategy to try to help. Although we have not done much formal research apart from proving focusing can be normal even though it often isn’t,  the approach seems to be very successful and often avoids eye interventions altogether.

We have prepared a leaflet for patients and parents here – but briefly:-

The Downslope

  • Focusing is normally an automatic process that we never think about
  • A child or young person has a problem at school or home with reading, attention, headaches or eye strain and someone helpful (often a teacher or GP) says they had better have an eye test to check it’s not that.
  • Even before the eye test the child then starts thinking about their eyes, even if they had never done so before
  • The optician then asks about blur or double vision – which EVERYONE gets from time to time – so, yes, they do notice them sometimes
  • The expert then tells them to note when it happens – so now they go looking for it
  • This checking can then become a “safety behaviour”. If the problem usually occurs for reading, for example, you start to go looking for it every time you read
  • The more you look for it, the less the process is automatic and the eyes unconsciously start to over- or under-focus
  • Then you start to have an “eye problem” – as well as whatever it was that took you for the eye test!
  • Because focusing is usually automatic, sometimes the things you do to try to make it better actually make it worse
  • You start to “catastrophise”. Could you have something serious wrong? Could you be going blind? What happens if you can’t do an upcoming exam?
  • Everything gets into a vicious circle of more anxiety (for the child, their parents and the professionals around them), worse eyesight and trying more treatments
  • The longer it goes on, and the more people try to help with stronger and stronger glasses, and the worse and more entrenched, it gets.

The Upslope

  • The professionals establish that the eyes are physically normal with a thorough set of tests, and some of their tests show that even if symptoms are severe, they can prove they can work normally, even if they often don’t. If there is anything that would respond to exercises or glasses, they will treat it
  • A thorough explanation that the eye symptoms are a signal that the person is getting anxious – so the problem is the anxiety, not the eyes
  • Recognise the triggers e.g. school socialising / bullying, reading, feeling anxious  – then do something about the trigger
  • It’s very common and almost always gets better with time and reassurance
  • It gets better quicker the less you think about it – so stop checking. And parents – try to stop asking!
  • Address the underlying problem e.g. talking therapy such as CBT, educational help for dyslexia. Many short term stresses such as bereavement, bullying or exams may pass or settle with time and help.
  • If this is not sufficient see your GP about getting mental health support or access some of the many self-help resources online. The  AnDY Clinic and the Charlie Waller Institute have lots