How Do We Effect REAL Change?

The preceding blog piece on whether vision occurs in the eyes or the brain, and its implications, generated quite a bit of discussion and positive feedback.  One of the more gratifying comments came from a parent commenting on a blog, Little Four Eyes, that centers on children with strabismus and amblyopia.

Stella’s mother writes:  “In the comment section you’ll find an interesting conversation in which the disconnect between ophthalmologists and optometrists is taken on directly and in a very civil fashion. I couldn’t help but chime in (possibly coming across like a hysterical idiot parent, but hey, I tried!) and I hope you will, too. After all, it’s been talked about here on Little Four Eyes frequently. The lack of clarity many of us face in making decisions about our children’s care would be alleviated greatly if the two fields could find a way to collaborate or at least communicate. This comment section interaction seems like a step in the right direction. Stella’s doctor thought it was great and I agree.”

So how do we take the next step and effect real change?  Ironically, looking back at a paper I wrote for an ophthalmologic journal nine years ago, all of the issues we’ve been discussing were essentially laid out, yet very little has changed.  You can read a copy of that paper, on The Interface Between Ophthalmology and Optometric Vision Therapy, reprinted in the Journal of Behavioral Optometry here.

The direction we need to take to meet the expectations, needs and welfare of the public is diametrically opposed to the information in an Audio-Digest presentation by a prominent pediatric ophthalmologist in 2007.  Here is a direct transcription of that doctor’s comments, in the context of continuing education on the subject of “The Eyes and Reading”, as delivered live to his colleagues and distributed through Audio-Digest:

Vision therapy breaks into two categories: orthoptics techniques from which it originally grew, and behavioral  vision therapy, which is where we get into trouble.  That’s the definition of snake oil.

Vision therapy gets misused by Success Stories on the Internet, pushing the guilt button of every parent who wants to know what they’ve done wrong for their child and why they’re not doing more.  Especially private school parents who are already paying money for their kids – anything they can do they’re going to want to do, and they have all these stories that are out there.  ‘After vision therapy Courtney’s improvement has been unbelievable.’  Statistically you’re always going to have some people who get better around the time they have vision therapy.  It’s like back pain – whatever you do it gets better.  This is my favorite line of all time.  This is on a website, randomly read by a random parent.  Ready?  This is what it says:  ‘Your child is smarter than their grades.’  How do they know?  [audience laughter]  I mean how do they really know my kid is better than his grades?  My kid may be dumb!  I mean how do they know my child is smarter than their grades?  Imagine how they make you feel as a parent though, if you’re reading this.

So whadda we know?  We know that vision therapy is like the carpenter who the only thing they have is a hammer.  Whatever they look at looks like a nail.  Right?  So there it is.  They hit it with everything.  Children may present with primary reading difficulties.  We know that.  And we also know that vision therapists are enthusiastic about it.  I’m gonna give them the benefit of the doubt and just say that they think it works rather than that they’re all charlatans, but that this is the only thing that they have.  What we don’t know is, does vision therapy actually work?  We don’t know that.  No one’s ever proved it.  And so, you have to be careful.  Because it’s not just oh, the kitchen sink.  Spending money means you’re spending money of that family, time of the family and the child, and the psychic energy of the family – keeping them away from the things that the kid should be doing to help them educationally.”

Stella’s mom, you deserve better.  And we in developmental optometry are determined to see that you, your family, and countless numbers of children who benefit from our services are not left to struggle.  It’s time to stop perpetuating the myths.  Once again, we invite our colleagues in pediatric ophthalmology to be accountable for their words as well as actions, and encourage as well as support parents who demand that their health care professionals seek and maintain higher ground.  That is how we will effect real change.

– Leonard J.Press, O.D., FCOVD, FAAO

7 thoughts on “How Do We Effect REAL Change?

  1. It’s becoming obvious that there is a disconnect between how ophthalmology and optometry define visual development. Regardless of those differences the snake oil comment is disturbing and disgusting. “Seek first to understand, then to be understood.”

  2. Hello Dr. Press! Thank you for your supportive comments here and over at Little Four Eyes. (By the way, I am a contributor there–the site actually is founded and run by Ann Z, a smart and devoted mom to a young daughter with strabismus.) This wonderful post poses the big and important question, and I’m so glad you’re asking it. Along those lines, I wonder if someone could start a clinic somewhere in which an ophthalmologist and optometrist work together to serve patients? This practice could churn out positive results and experiences for patients and serve as a model for others, perhaps. We can dream, anyway.

    One point of confusion I had from the debate/conversation in the last piece were statements like “Pediatric Ophthalmologists are the most qualified group to care for the child’s visual system.” While my experience does not seem to support that assertion, it’s not even the point. (We have both involved with Stella’s care.) An example: When my daughter, as a baby, refused to eat and required a feeding tube, we consulted several experts to tackle the problem from all angles. If I’d relied on only one, especially GI doctors or her pediatrician, she’d still be on a feeding tube today, I have no doubt! Many kids get stuck on them for that reason. Those doctors were helpful with figuring out what the core issue was (to the extent possible), and could provide things like a feeding tube and surgery if need be, but they did not know how get my daughter to then learn to eat normally. They said she would “just turn it around,” and that never happened. I needed other help and thankfully found it. Oddly, her vision situation is quite similar. An ophthalmologist did an excellent job determining her condition and prescribing glasses and patching, but couldn’t or wouldn’t offer anything further to ensure the best possible vision for my daughter. Past experience told me not to go with what the first (or even second) doctor told me! We could do better.

    It’s not about “who is best” but “how can we collaborate to provide comprehensive vision care that ensures the best possible outcomes?” Most kids need both points of view. I’m not sure how to encourage more openmindedness from ophthalmologists, but I see more and more studies coming out endorsing VT (don’t even get me started about neuroplasticity!) and I am sure that will continue. Unfortunately, in the meantime, many are missing out on opportunities for better care. If I hadn’t had our past medical saga to learn from, I don’t know if I would have thought to keep questioning and pushing until we found VT. So for all the kids out there not getting all the help they need, keep the conversation going and thank you so very much!

    • You’re welcome,Amber. Thanks for clarifying your contributions to Little Four Eyes. I was just informed that you have your own website dedicated to Stella’s journey, and it is beautiful!

      Your comments are spot on. Keep dreaming. I’m encouraged by looking at the synergy that exists between physical therapy and orthopedics now. I’ve been around long enough to recall when the two groups were at considerable odds.

  3. A few years ago I had a pediatrician referred to me because of difficulties she was having with vision when wearing her toric contact lenses for excessive myopia and astigmatism. She had been using monthly standard lenses with less than optimum comfort and vision. To keep this from becoming a contact lens problem solver I’ll skip to the relative subject. I attempted to educate her regarding InfantSee and asked if she would be willing to place some brochures inher waiting room. These did not have my name on them and I wasn’t looking for referrals,I assured her. I said that when she ran out of these I would be happy to have the AOA send more to her. Two years later, and bi-yearly visits, she never requested more brochures. I am in my 49th year of practice and have been involved for most of those years with pediatric optometry,visual training and developmental vision. I’ve been a consultant to public and private school and spoken to parent groups. But when it comes to their children it is the Pediatrician that is GOD. They consult him/her for any therapy that is recommended to them for thie child and was not discussed by the ophthalmologist that the pediatrician had recommended. 49 years and nothing has changed of significance and probably won’t in the next 49 either. The brotherhood of medicine/pediatric ophthalmology is too strong. Their prejudices are instilled during their rotation in ophthalmology during their medical school training. We can only continue to educate one set of parents at a time as they somehow find their way to our door. We’ll continue to fight the good fight but it will have to be from within because there’s not much help from the other disciplines involved in the development of children.

    • That’s the point, Chuck. Technology has presented us with a tool where parents can network with each other more readily than even before. The attempts of the groups you mention to actively repress our services will be less and less effective, as parents will separate rhetoric and dogma from substance.

  4. Thank you for your efforts to communicate the importance of serving the needs of our patients. The ongoing conflict between optometry and medicine is about ego, money, and power. Vision therapy is an effective treatment for improving a child’s visual abilities. These abilities are part of the learning/reading process. The medical profession has consistently communicated that focusing and tracking problems are part of a child’s learning problem/dyslexia. For this reason, these problems should be addressed from an educational perspective. On the other hand, educators have been referring many of these children because they are unable to address these visual problems. For the parent, it is Catch 22. Developmental/Behavioral optometrists have been able to minimize this visual interference factor in many children. Vision therapy is not a panacea for all learning/reading problems. For each child to reach their ultimate potential, it requires an interdisciplinary approach. It requires professionals, who are working together for the sake of their patient. The medical position and arguments are becoming very old and irrelevant. It is time to focus on the positive attributes of different therapies versus maintaining an obviously biased professional viewpoint.


    PS As a simple experiment – try reading with your eyes closed. It may give you a clearer vision of the power of vision in the act of reading and academic performance.

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