Ophthalmology Owes You An Apology

Who is “you”?  And why would Ophthalmology owe you an apology?  “You” is any patient who has ever been told that vision therapy is bogus.  Or a scam.  Or “a waste of time and money”.  Now thankfully that hasn’t happened in my practice for quite some time.  But it still happens to colleagues of ours in different parts of the country, and it is a form of professional bigotry and ignorance that must stop.  It’s bad enough when an ophthalmologist or pediatrician gives a parent a false sense of security that everything is fine.  It’s far worse when an unsuspecting parent takes their child to one of these professionals for a second opinion and is told that nothing further can or need be done.

Let me give you a quick for instance of a child who I examined this morning.  Eve is a 7 year old girl who has been treated by a pediatric ophthalmologist in another area of our state for over a year.  She has been given glasses for farsigthedness, stronger in one eye than the other, together with patching of the left eye to improve amblyopia of the right eye.  So far so good.  During the past few months, however, Eve has been having headaches which usually occur during homework or reading.  She has been skipping words and even lines when reading, and has been having increasing difficulty with spelling.  Mother brought this up as a concern, and here is what the ophthalmologist wrote in her letter:

On examination, vision was 20/20- in the right eye and 20/20 in the left eye with her current eyeglasses.  There was no strabismus and no evidence of convergence insufficiency.”

That’s it.  Period.  End of story.  No strabismus or convergence insufficiency, therefore no link between her visual problems and the performance issues that Eve’s mother had raised. 

Wait a minute. Something seems to be missing here.  Just because a child reads an eye chart across the room reasonably well with either eye, does that mean her amblyopia has nothing to do with her headaches when doing homework or skipping lines when reading?  That, my friends is the  crux of this issue.  When an ophthalmologist tells you that everything is fine, but the optometrist tells you that it isn’t – and that vision therapy can help – it’s because the ophthalmologist is limiting her scope to what the eyes are doing in isolation.  From that limited viewpoint, everything is fine.  Now here’s where the apology comes into play.  Your ophthalmologist should know better.

Let’s assume, for argument’s sake, that an ophthalmologist can be excused for not being schooled in optometric literature.  What excuse is there for not being current in ophthalmologic literature?  I was reminded of this today when a colleague forwarded a link from Medscape to a research paper in last month’s Investigative Ophthalmology and Vision Science.  It supports the concept that amblyopia affects the visual system in terms of eye-hand coordination, and is just the latest in a series of publications over the past few years showing how antiquated the pediatric opthalmologic notion of “normal” vision is.

Don’t hold your breath waiting for the apology that is owed to you.  Go one step better.  Join Sovoto as a member now.  You will note that there is already an active discussion forum for adult patients with strabismus who share their experiences in vision therapy.  Do the same if you are the parent  of a child with learning or performance problems.  I’m going to suggest this to Sean, the father of one of my patients who wrote a beautiful Success Story that inspires me:

“There has been a monumental change in my son’s visual abilities.  It could not have gone any better.  After years of additional reading classes, trips to pediatric ophthalmologists, neurologists, and Child Study Teams, we finally found a doctor whose system of analysis, therapy, and ongoing reviews has transformed my son’s life.”

Research will eventually help Ophthalmology catch up to what Optometry already knows.  In the interim, follow the ancient Chinese proverb and light your candle to combat the darkness.

– Leonard J. Press, O.D., FCOVD, FAAO

13 thoughts on “Ophthalmology Owes You An Apology

  1. What a great way to explain something that continues to confuse so many parents and patients. I have already suggested that several of the parents of my patients, as well as my patients read and comment on this blog. I would add “there’s none so blind as those who will not see” to the ancient Chinese proverb of “light your candle to combat the darkness.” I wish it were not true, but I don’t think we should hold our breath waiting for an “apology from ophthalmology!”

  2. Thank you, Dr. Stan. Drive patients to the blog, fuel discussions and comments, guide them to join Sovoto, empower them to help others through discussion groups. Much as social revolutions have toppled dictatorships, it will topple the ignorance and arrogance of professionals whose beliefs cloud the facts about what patients accomplish through vision therapy.

    • You’re welcome, John. Consider which of your patients might start a http://www.sovoto.com Discussion Group on Vision-Based Learning Problems. There are some great parent bloggers out there already for children and amblyopia, like “Stella’s Mom”.

      While individual patient blogs will continue to grow, having a centralized source like Sovoto for vision advocacy will be highly useful for patient education. Thanks as well for all that you do.

  3. Fantastic post, Dr. Press. Thanks especially for the link to the research paper. We were just putting together a post on children and amblyopia, and we’ll definitely work that in.

    I simply don’t understand why someone in the medical field wouldn’t so stubbornly ignore the positive impact vision therapy has had on so many people. My wife is a teacher, and she’ll do anything to help her kids. I wish other professionals could exhibit the same behavior.

  4. Len,
    Excellent post! If I could have a dollar for everyone time a parent has said to me “Why didn’t my ophthalmologist tell me about vision therapy?” I would be one rich woman right now! Thanks for putting the facts out there!

  5. I wanted to add another flicker to this flame.

    I have a very pragmatic concern about the system of analysis by which some eye care professionals judge “vision.” Before I attended VT, I had to go for evalutaions twice a year to have my contact/eye glasses prescription adjusted (read increased). Almost every time the appointment would start with an inquiry as to how well I could see. Unfortunatley for me, I almost always responded that I had been having increased trouble “seeing.” The strength of my lenses would be increased, and off I’d go, thinking (and being told) that I’d been handed the solution to my problems. Now I could “see” again.

    My concern is that frequently I would ask if it was OK to drive. I had less and less confidence about driving. I couldn’t explain why I wouldn’t drive through certain intersections but others were fine. I would drive in a huge circle to avoid making certain left (or right) turns, but others were fine. All I could express was a fear to these doctors: it just didn’t “feel” right to drive sometimes. (Years later, I would learn that it was things such as that the traffic lights were placed at the wrong angle for me at those exact intersections. I couldn’t quickly shift my view between potential pediastrians and lights. It was other things such as too many reflecting windows in the building near the traffic light, etc.)

    Every vision care visit, my honest concerns were brushed away (by the doctors and hence me) since I now had a new prescription and saw “20/20” again.

    Well, I’ll tell you *some* of my previous eye doctors (opthomologists and optomitrists) owe a bunch of people an apology. They owe their own spouses, kids, and property owners at those few intersections an apology. Nothing ever happened (thank God) but that is probably because I am a really, really responsible person. I jumped through hoops to avoid those intersections (or parking lots) or I would plan my entire day around driving through them at “off” hours.

    I have absolute confidence that (almost all of) those doctors were doing their best to help me drive safely, too. They were giving me a straight answer as best as they knew how at that moment. They owe themselves forgiveness for their part in this. But they do owe it to everyone at intersections where their patients (patients with fewer resources than I do) drive to recognize that the real world isn’t just about 20/20. That’s the starting point to the evalutation, not the end point.

    • You make several excellent points, Pamela. Driving is a life or death issue, and we know that the issue of traffic safety tends to be trivialized, certainly with regard to vision. It’s a sad commentary that the only requirement for driving in the United States is visual acuity. In most if not all states you can qualify for a driver’s license if you have 20/50 visual acuity in one eye. You needn’t have a second eye. This is a seriously lax requirement, and doesn’t begin to address the type of visual insecurities, instabilities, or uncertainties you describe above. Until and if there is a concerted effort to identify the visual requirements of driving that relate to safety which can be mass screened or testing, we’ll persist with the notion that as long as someone sees an eye chart clearly, vision is adequate for driving and most other activities of daily living.

  6. Actually, Dr. Press, you bring up an interesting story. My daughter’s college freshman roommate is completely blind in one eye (born blind in that eye) and her “good” eye has vision problems, too. She has a restricted driver’s license. However, she is a wonderfully responsible person. That, coupled with the fact that she’s developed her visual perception of the world with a single eye from the word “GO” and I (before VT) was trying to cope with an ever-changing visual world, led me to prefer her as a driver over myself (in specific situations). I would have prefered her to drive through the parking lots and intersections which were confusing for me.

    As a matter-of-fact, she was driven through one of my challenging parking lots by my daughter. Afterwards, I asked her if she remembered it. She remembered the anchor storefront and roughly what two of the pedestrians were wearing (she’s super smart). To me, that says it all. I doubt I would have remembered anything except for an ill-defined sense of “something’s wrong.” She could “see” better than I could in that particular case even though she’s the one who is legally vision impaired and I was the one with “perfect” vision legally.

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