A colleague sent along this video tonight and though I’d seen it before, and we’ve been using the VEP unit in our office for several years, I had forgotten how much I enjoyed the clip. You may recognize the name of the pediatric ophthalmologist in the video, Dr. David Granet, from his well-known paper on the association between convergence insufficiency and ADHD reviewed on visionhelp.com.
Dr. Granet makes some nice statements on this segment of The Doctors TV Show. In describing the relevance of screening a young child for amblyopia, he states: “The eye is just a camera, and then you have to get it back to the CPU, the central processor. The brain waves tell us what she can see or can’t see. Amblyopia is when the brain isn’t using one eye.”
That’s a pretty profound statement, which says that poor vision in one eye, or what is called “lazy eye” in the vernacular, really isn’t a lazy eye at all. In fact, it’s more appropriate to call the condition “lazy brain”. But if we called it that, we’d really be casting aspersions on the person with the condition. So the concept that Dr. Granet is supporting is that vision occurs in the brain, not in the eyes.
This is also a crucial concept to grasp because the American Academy of Pediatrics and the American Academy of Ophthalmology have an absurd Policy Statement used to discredit vision therapy which states: “Although the eyes are obviously necessary for vision, the brain interprets visual symbols. Therefore, correcting subtle visual defects cannot alter the brain’s processing of visual stimuli.”
Huh? Wait a minute. If correcting visual defects cannot alter the brain’s processing of visual stimuli, how do we improve amblyopia? Aren’t we treating the connections between eye and brain? Optometry understands this, of course. Vision is a collaboration of the eyes and brain, and this serves as the basis for success in vision therapy for amblyopia as well as many other conditions.
Thankfully Dr. Granet doesn’t get tripped up on this point in his presentation. In fact, he sounds like a developmental optometrist when he comments in the video on the importance of treating amblyopia at a young age. Why? “I need to get it now, and for learning purposes, for school, I want her to be ready. I want her to have both of her eyes available to do everything she needs to do in life at this most important developmental time.”
Okay, we can forgive Dr. Granet for not appreciating that amblyopia can be treated successfully after the age of 10 or 12, as our colleague Dr. Dominick Maino pointed out in a nice review article on neuroplasticity. After all, this may prove to be a harbinger that pediatric ophthalmologists will one day grasp the full extent of vision therapy. Dr. Granet concludes that it’s unconscionable that these kids aren’t detected and treated. We couldn’t agree more.
– Leonard J. Press, O.D., FCOVD, FAAO