Thanks for all the great comments posted as well as those I received off line to our most recent blog post about underinformed and misleading statements made by ophthalmologists about optometric vision therapy. In that vein, a colleague asked if I had seen the latest information on the Children’s Hospital Boston website about vision therapy. I hadn’t, and it’s worth sharing some observations about it.
Firstly the logo is inviting and implies that “Love + Science” = Great Doctor/Patient Collaboration. Very noble, but lets dig deeper. In a section on Vision Therapy the website notes:
Children’s Hospital Boston is one of the few pediatric hospitals in the country to venture into the field of vision therapy. David G. Hunter, MD, PhD, ophthalmologist-in-chief at Children’s, explains: “While many ophthalmologists think vision therapy doesn’t work—they truly believe that practitioners are taking advantage of patients who need help—I have seen enough treatment successes that I think it has to be studied. Here at Children’s, we want to offer this service to our patients rather than give them no choice but to seek help elsewhere, and at the same time study its effectiveness.”
Excuse me? “Give them no choice but to seek help elsewhere”? My goodness! Talk about walking a tightrope. Hard to tell if this is a left-handed compliment, or a prominent ophthalmologist feeling his way cautiously. To paraphrase, “many of my buddies think you’re shysters preying on an unsuspecting public, but I think you folks may actually have some substance, as elusive at it is to figure out how or why. ” This very much reminds me of a guest editorial I wrote for the Journal of Behavioral Optometry 21 years ago. (Perhaps this is one of those concepts that takes many years to come of age.) In it I cited the opinions of two prominent pediatric ophthalmologists, Leonard Apt and David Guyton, in the discussion section of an article in the Transactions of the American Ophthalmologic Society. Dr. Apt stated that the unsophisticated approach of ophthalmologists brought to bear on these issues (reading and learning problems) oftentimes is not helpful, and the patient leaves dissatisfied. When proper care isn’t given, and the problems persist, the patient winds up under the care of an optometrist. Dr. Guyton suggests that ophthalmologists may not be measuring pertinent functions during their exams, and perhaps that’s why the ophthalmologist feels the patient’s vision is normal.
Now here’s the kicker. The Children’s Hosptial Boston website continues: “For this reason, Children’s recruited Aparna Raghuram, OD, PhD, to offer some types of basic vision therapy while charging just enough to cover our costs. Raghuram is trying to simplify vision therapy and offer only the most promising treatments. Children’s is also planning to set up clinical trials to use science in order to see what works. ”
How curious. Let me give Children’s Hospital Boston another clinical pearl, one that comes from a concept I explored in significant detail in another JBO guest editorial. It would be best not to cloak patient advocacy purely in the trappings of scientific concern. What you’re implying is that any treatment rendered in your hospital should be provided at cost, rather than for profit, until it has met the same criteria for clinical trials that you are setting up for vision therapy. If so I would venture to say, as Ricky said to Lucy, you gotta lotta ‘splainin’ to do.
Perhaps we’re finally starting to speak the same language. As the CITT showed, it takes many, many years to conduct a gold standard clinical trial. And even when the trial is conducted, and it proves that office-based vision therapy is far superior to home-based vision therapy (which is tantamount to placebo therapy), ophthalmologists are still slow to let go of the dogma.
I admire your foray into this field, and ultimately you’ll grow more comfortable in understanding how to keep the baby in clear bathwater. It takes years to become proficient in optometric vision therapy, and there is a board certification process that you should consider for your staff. In the interim, and this is the key, don’t begrudge patients for seeking care elsewhere. While love and science are important ingredients in good clinical care, it also requires a serious investment of time and resources. Don’t be shy about charging reasonable fees for your optometric vision therapy. Patients understand that you often get what you pay for. And to do vision therapy well, one needs to make a significant investment in staff, in equipment, in knowledge, and in management skills. We and our predecessors in developmental and behavioral optometry have pioneered and excelled in this field. It’s time to show us some love. Your patients will hug you for it.
– Leonard J. Press, O.D., FCOVD, FAAO