Dr. William Padula, an optometrist in Guilford, was recently performing a routine vision test on a little boy in his office.

He held up a stick in front the boy's eyes. "Now I'm going to step back, and I want you to look closely at this stick and then tell me at what point this one stick looks like two sticks," he said.

The little boy said, "I see two of them right now."

"Did you ever tell anybody that you have double vision?" he asked the child.

The boy looked confused. "No," he said. "I didn't know."

Padula smiles as he tells the story. This isn't an unusual exchange between him and his patients, you see. He knows that often people don't have any idea that other people don't see the same things they do.

After years of listening to people tell what it is they're really seeing, he's realized that neurological problems, traumatic brain injuries, or even developmental differences, can cause people's brains to process information quite differently from other people-and that it has nothing to do with whether people's eyes are functioning.

"You can be able to see quite clearly and yet still not be able to process what your eyes are seeing," he says. "I see neurologically challenged people who describe words moving around on the page, or they tell me that the floor seems to be tilted. What's happening is that an area in the mid-brain has been injured, and they can't interpret correctly the information that their eyes are sending to the brain."

Now Padula, who for the past few decades has been studying this phenomenon, has opened the Padula Institute of Vision. This will expand the services he gives to patients beyond what is normally thought of as optometry. He's now including specialists to provide occupational, educational, speech, and reading enhancement therapy, as well as doing brain-wave testing for head injury patients.

This is actually nothing new for him — just an opportunity to have everything in one place.

"My dream has been to develop a model where therapists and educators can work together to solve people's problems," he says. "We've been here one month, and I'm already seeing it happening. Every therapist here is working with the others to combine approaches to vision and brain function."

This work has been made possible by several major discoveries in the last few years which have shown that people have two visual systems: an ambient spatial system, in which the brain takes in information from the periphery of your sight and gives you information about where you are in space, and the focal system, which allows you to look directly at something and concentrate on that fixed point.

"In any neurologic condition, or brain injury, an imbalance can occur between the ambient and the focal visual processes-and then you have difficulty with balance or with reading," he says. "Doctors used to see the damage as being a muscle problem, but now we see that it's a mid-brain problem, caused at the time of the injury. The mid-brain can get jarred, or torqued, and stops communicating to the higher brain."

For years, Padula has been treating the vision problems of neurologically challenged people with special prism glasses, which make significant changes in the way people can perform.

"From the second someone puts on the special prism glasses, they can balance their visual systems," he says. "This message is one I constantly deliver: after a brain injury, a neuro-optometric specialist should examine the patient for this kind of visual problem. Oftentimes people don't get treated for this for two, five, or even 10 years after the trauma, and by then so much time has passed. They can still regain their single vision back, just as it was before — but what a shame to have to go through so many years without it."

Padula's work has taken him all over the world, giving lectures. Recently he's been invited to open an institute in China, treating people with visual problems stemming from strokes and brain injury.

He's also recently developed a system for reading enhancement, called Letter Dynamics, which, when used with pre-school and elementary-age children, teaches them to read by using both their vision and motor skills, he says.

And his Guilford office will soon include Insight for Rehabilitation, a not-for-profit corporation like the one he had at Easter Seals, treating people with special needs.

"I've always had a strong interest in not-for-profits because without them, so many patients fall through the cracks," he says. "I want to include the population of patients that some people think of as 'forgotten.' Autistic patients, for instance-who's examining their vision? Doctors may look at their eyeballs but not at the underlying processing problems that people with autism have."

In the meantime, Padula's practice still has room for patients who just may need a pair of glasses as well.

For more information, call his office at (203) 453-2222, or (800) 591-1160. The address of the Padula Institute of Vision is 37 Soundview Road, Guilford.