The Role of the Therapist in Vision Therapy: Part 1


The title of this piece is an updated version of an article by Dr. Martin Birnbaum, The Role of the Trainer in Visual Training, published in the Journal of the American Optometric Association in 1977.  VT – BIRNBAUM – ROLE OF TRAINER IN VT – JAOA 77.  The article is  still timely, though in the ensuing years VT evolved into a therapeutic rather than a “training” discipline, hence it would be more appropriate to speak of the role of the therapist in vision therapy.  More importantly, the increasing number of adult patients in our practices, particularly those with strabismus, are aiming a spotlight on something that doesn’t get much as much attention as it deserves.  That is, the role of the adult patient’s psyche in vision therapy.  This was brought to my attention by Sue Barry, who ultimately helped me understand how pursuing vision therapy as an adult requires opening a door to old memories as much as it presents the opportunity to form new visual patterns.

Enter Susanna Zaraysky, a linguist who was born in Leningrad with infantile strabismus, and placed in a school for developmentally disabled children at the age of two. Her parents, both engineers, immigrated to the United States in 1980, where of necessity Susanna became the interpretive voice of the family.  Her first strabismus surgery was at age 3 and she would undergo another procedure as a teen to cosmetically improve her strabismus.  Fluent in seven languages, Susanna  believes that her auditory/speech-language system became attuned because her visual system was attenuated.   That sensitivity, coupled with the realization that she hears language as music not as words, is the source of her talent.   As she explains it, “It’s as though my ears are the third dimension that I don’t have with my vision”.

Susanna now actively participates in the Sovoto Adult Strabismic Patients’ Forum, and raised an important set of discussion points about psychological help for adult strabismic patients.

Developmental optometrists and vision therapists, please incorporate psychological assistance into your practice for adult strabismics doing VT. The non-visual side effects (nausea, extreme fatigue, motion sickness/vertigo, sensitivity to noise, inability to concentrate, etc, etc) are enough to drive a sane person crazy, not to mention the visual changes of intermittent double vision, moving objects, seeing people with two noses and four eyes, and the changes in depth perception.”

She continues, “I know you are not trained in psychology, but perhaps you could recommend therapists to your patients who are struggling with the changes to their brains and vision. As we rewire our brains, everything is effected in our lives from our vision, interpersonal relationships and way of life.”

I asked Susanna to outline for me what she felt these needs were, and she sent me a very insightful set of observations.  It’s rather lengthy, so I will relate her concepts in Part 2, but it’s worth noting here that  Susanna was influenced to pursue vision therapy after discovering Stereo Sue’s journey.

– Leonard J. Press, O.D., FCOVD, FAAO

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