Dr. John Abbondanza is someone we’ve blogged about before. He is an esteemed colleague who does great work within our profession. The CBS affiliate in Boston ran a generally nice piece about the work that Dr. Abbondanza is doing through optometric vision therapy, and we posted it on our Facebook site this morning.
The title of the piece seems a bit odd: Unusual Therapy Helps Kids Struggling In School. It reminded me of the New York Times Sunday Magazine piece last year that painted vision therapy as controversial, citing the opinion of pediatric ophthalmologists who characteristically qualified vision therapy as “unproven”. This position is a willful or unintended ignorance, based on a very selective review of available data. Even if one were not aware of the science at hand, absence of evidence is not evidence of absence. Lord knows pediatric ophthalmology has relied on this principle in advocating its own interventions, a double standard that Dr. Dominick Maino exposes in a recent editorial.
“Vision therapy, in the vast majority of children, does not play a role in helping a child read,” said Dr. Melanie Kazlas, a pediatric ophthalmologist at Massachusetts Eye and Ear Infirmary and Children’s Hospital. Kazlas recommends traditional interventions like working with a reading specialist. “There is no harm in such treatments yet we don’t want the child to have a delay in having more effective treatment,” she said.
In my experience, and that of many of my colleagues, there are two kinds of pediatric ophthalmologists who pass judgment on optometric vision therapy in the guise of expertise. One is the ophthalmo-agnostic, the disbeliever who doesn’t know what she doesn’t know. The other is the ophthalmo-atheist, the disbeliever who discounts any benefit to vision therapy because it has no fundamental redeeming value. There would be no harm in these opinions if they did not delay the child from receiving more effective treatment.
This is reminiscent of an earlier post in which I cited one of my favorite New Yorker cartoons. Two dogs handsomely dressed in a bar raise martini glasses to each other in a toast and declare:
“It is not enough that dogs succeed; cats must also fail.”
It’s actually an adaptation of a quote from Gore Vidal who quipped that it is not enough to succeed, but others must fail. Think about it for a moment. Here we have the mother of a child who is also a student in her second grade class. She is clearly more of an expert in education than a pediatric ophthalmologist. Yet this teacher’s son already began to show signs of not keeping up in first grade. If traditional educational intervention had helped, his mother wouldn’t have sought the optometrist who was ultimately able to help him thrive.
This is true of the majority of children with vision based learning problems that we see. Their parents have been told by pediatric ophthalmologists that “everything is fine”. They have 20/20 sight and their eyes are healthy. They’ve already had “traditional interventions like working with a reading specialist”, as Dr. Kazlas suggests. Yet they continue to struggle. Even then, most pediatric ophthalmologists cannot bring themselves to admit that optometric vision therapy might be beneficial.
Yet despite the determination of “experts” like Dr. Kazlas to discount the benefits of optometric vision therapy, patients like Jacob Snoeyink find their way to doctors like John Abbondonza because parents like Marah Shoeyink can see through the thin veil of concern.
Now for another touch of irony. The same institution (Mass Eye & Ear) housing the “expert” interviewed for this article publishes a newsletter that, three years ago, carried a front page article about a gentleman who had severe balance disorders. He was diagnosed as having Meniere’s Disease, underwent rehabilitation therapy at the hospital and engaged in activities that help to develop his balance, such as becoming a student of T’ai Chi and Chi
Gung energy arts. As you read the article in the newsletter you’ll gain the sense that the institution’s thinking regarding the ear is much broader than its thinking about the eye. Perhaps there will be similar enlightenment for pediatric ophthalmology down the road, and a good place to begin would be to read the Clinical Practice Guidelines on Care of the Patient with Learning Related Vision Problems (CPG #20). Then we’ll talk more.
– Leonard J. Press, O.D., FCOVD, FAAO