An Open Letter to Dr. X

Dear Dr. X:

I’m using just one of the letters of your last name so that we can keep your identity anonymous, if you wish.  A close colleague of mine, who practices developmental optometry and vision therapy, forwarded your letter which was shared with him by a one of the local doctors to whom you wrote your open letter dated December 1, 2011.  The letter is very familiar – I’ve seen similar versions from pediatric ophthalmologists seeking to discredit optometric vision therapy and purposely confound the public.  It can be summarized quite simply by the following graphic:

Since 1972, that’s nearly 40 years now, the professional organizations to which you belong have been like a dog on a bone in this crusade to ostensibly protect the public from misinformation about vision, learning and dyslexia.  As my colleague, Dr. Dominick Maino has referenced, this is a campaign that is transparent in its hypocrisy, duplicity, and double standards.  Your letter is a perfect case in point.  You write:  “There is no scientific evidence that dyslexia is a visual disorder or that eye training or vision therapy alleviates this disorder.  Time consuming and costly vision therapy gives parents and educators false expectations for improvement.  Its high cost is unsupportable at any time, but particularly so in these difficult financial times.  I have 9 years of training in medicine and ophthalmology … I would be delighted to provide vision training for my patients if scientific evidence supported its use.  Vision therapy is extremely lucrative for those who practice it.  On occasion, children will present with convergence insufficiency, or the decreased ability to keep their eyes in the convergent position when reading.  Presenting symptoms include fatigue and blur with prolonged close work … I evaluate each child for this condition and can prescribe convergence exercises, including computer software where appropriate.”

So here we have the crux of the issue.  You resent that Doctors of Optometry are able to render lucrative vision therapy services.  After all, if there were scientific support that satisfied you, you would render the services yourself.  The fact that you have no training in optometric vision therapy is immaterial.  After all, a buck is a buck, correct?  But wait a moment.  In these economic times, as you note, parents and educators need to be safeguarded against professionals who appear to be taking advantage of the public.  I couldn’t agree more.  Parading one’s credentials in medicine and ophthalmology is not a substitute for living up to the standard of one’s own literature.  Something about the Emperor having no clothes comes to mind.  You can gain a deeper understanding of this here.  As you will note, even the approach in your letter toward treating convergence insufficiency is not supported by current research.

Permit me to share with you the perspective of an M.D. who does not have an axe to grind.  This M.D. is the mother of a child who underwent vision therapy.  She wrote the following letter to a colleague of mine who wrote a book about children who struggle with undetected or untreated vision based learning problems.  Again, I have removed the names to keep this generic:

“I just finished your book last night.  It was what I had been looking for:  a general explanation of the different types of vision problems that vision therapy helps.  Now I am better prepared to explain to parents why they should take their kid to a certain optometrist even though they had a normal vision exam at another eye doctor’s office.  Since XXXX started vision therapy and I have observed firsthand the wonderful changes that have occurred, I have lost track of how many patients I have referred to Dr.  YYYY  and two other developmental optometrists who live in our area.  I have a new purpose in life:  I will do everything within my power to educate others about vision and how vision therapy can help, including parents, teachers, and especially other pediatricians.  Someday, I hope that all doctors will have learned about the topics covered in your book and that even the ophthalmologists will refer their patients to vision therapy.  I hope the American Academies of Pediatrics and Ophthalmology rescind their joint statement against vision therapy. Thank you again for the work you have done in this area.  I know you have changed the lives of many.”

You opened your letter, Dr. X, by stating that you are frequently asked to evaluate children who are having difficulty learning to read.  That thought should be of concern to all parents who would learn by reading your letter that dyslexia simply reflects a deficiency in phonemic awareness.  If a child is struggling with reading, the answer lies in heaping more phonics.  Vision cannot possibly be a contributing factor.

Consider this.  I participate in an online professional forum through LinkedIn.  It is oriented toward Reading Teachers & Tutors involved in dyslexia.  Here, again, are the words of a mother who would find your position on dyslexia naive and uninformed:

“I have to say I am finding this thread fascinating! As the mum to a daughter with dyslexia, I can only say that for her, phonics was a failure. At the age of 11 her spelling is still appalling and her reading level is still 2 years behind her peers. Her school was teaching the Spalding method focusing on all the sounds that the letters make. This was done daily from kindy through to year 4 yet even now she still gets confused. If she tries to sound out words for her spelling, there are always elusive strange “g’s” or extra “e’s” added and as hard as she tries she just doesn’t get it. We have tried speech therapy, tutors, Fast Forword, Multi lit, and spent THOUSANDS. I am still at a loss, but have to wonder if in her kindy years she had been confronted with more of a whole word approach, would this have had any benefits at all for her?? To be completely honest, what I think would help my daughter more than anything in her struggle with this learning difficulty, is an education department who is actually willing to help her. She was exhausted from her regular homework and tutoring homework and all the other extra work that she needs to do just to keep up.”

As you can see, Dr. X., the answer to dyslexia is not always “more phonics”.  Nor is it necessarily vision therapy, as you well know from reading our policy statements.  In reality the condition is sufficiently complex to defy any singular intervention.  Your letter ends with the invitation for the recipient to contact you with any questions regarding dyslexia or vision screening.  Perhaps the most important question is why your representation of the issues are conveniently selective, and why your letter omits peer-reviewed research on the role of vision in reading.


Leonard J. Press, O.D., FCOVD, FAAO

4 thoughts on “An Open Letter to Dr. X

  1. As was once said in a famous movie – “what we have here is a failure to communicate.” We (optometrists) say “learning-related vision problem”, they (ophthalmologists) hear “dyslexia.” We say “vision therapy” , they hear “orthoptics.” It is almost as if we are speaking two separate languages. I have found this to be true even when communicating with my optometric colleagues. Presenting research becomes irrelevant if the reader does not understand the language. I have found this to be very frustrating over the years and a major barrier to acceptance of what we do.
    -Rob Fox, O.D.

    • That’s a significant part of the problem to be sure, Rob. But something tells me there are other factors operative here. Part of it is rooted in a professional ego or arrogance, hence the “I went through 9 years of medical school and residency, and if this stuff worked I would surely do it”. The intimation is that this MD feels she can do anything that ODs do, irrespective of the fact that she hasn’t received any educational training or clinical experience in it. She feel tossing a patient an HTS like a frisbee once a year and wishing them luck gives her the authority to be an expert in who needs VT and who doesn’t. It must irk her to see patients who she considers to be perfectly normal or fine subsequently experience the benefits of VT. Hence the letter she wrote to physicians in her community attempting to re-establish her dominion over all things visual. This seems to be a trend among pediatric ophthalmologists in different areas lately.

  2. Well, if Dr. X thinks reading doesn’t involve vision, then I must refer him to Dr. Seuss’s book: I can read with my eyes shut!! I think Dr. Seuss is the real geneis here. If we could just eliminate vision from reading.

  3. Some people say “My mind’s made up. Don’t confuse me with facts.” Computer experts say “(GIGO) or garbage in, garbage out. The problem lies more with educators of these doctors; OMD and OD.


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