Occupational Therapy and Developmental Optometry Collaboration

Our colleague, Dr. Dan Fortenbacher, blogged last May about the natural synergy that we have with occupational therapists engaged in sensory integration therapy.  I’ve been reminded of that repeatedly this month, in the midst of a stretch of continuing education seminars that I give to OTs, PTs, SLPs, and Educators for CMU Premier Education Solutions.  Two more are upcoming in February, one in Toms River and the other in Atlantic City.

Here’s information about Sensory Integration from the Health Issue page on the website of the American Academy of Pediatrics:

Sensory Integration Training

Dr Jean Ayres, an occupational therapist, developed the theory that much of the hyperactivity in today’s children is the result of poor sensory integration—that is, the failure of the brain to organize and make use of information derived from such senses as vision, hearing, smell, taste, touch, motion, and temperature. According to this theory, sensory integration dysfunction makes it difficult to concentrate and sit still, and puts children at risk for learning disabilities, problems with coordination, social difficulties, and touch sensitivity. Ayres claimed that sensory integration dysfunction is usually genetically inherited or acquired prenatally, during birth, or from environmental toxins. Recommended treatment includes exercises or experiences that provide the child with extrasensory stimulation and feedback—such as brushing and rubbing of the skin, deeppressure exercises, vibration, stretching, and so on.

While this approach has some intuitive appeal, feels good to children, can be calming, and is said to address the poor coordination and social difficulties that many children with ADHD experience, no convincing evidence has surfaced to prove that deficits in sensory integration are a cause of related disorders. Studies have not shown that sensory integrative training succeeds as a treatment for children with ADHD or learning or behavior problems. While not known to be harmful in any way, the expense and time demands are such that this approach cannot be recommended as a treatment for ADHD.”


Aside from the many wonderful examples of O.T. and O.D. collaboration in optometric and occupational therapy sources, I was reminded yesterday as I was giving my seminar that we have a major challenge in common.  Despite all the good work we do, and the many thousands of patients we have helped, our interventions are dismissed by national medical organizations as unproven.  These are the same organizations who uncritically peddle off-label experimental use of amphetamine derivative and anti-psychotic medications for children with attention and learning difficulties.  I get a roomful of knowing nods when I ask OTs whether the AAP wouldn’t be better off not sticking its nose into an area where a little knowledge is a dangerous thing.  That is why, when third parties look more closely at the fact that the AAP has joined ranks with the AAO in Policy Statements about optometric vision therapy, they can readily see that little meaningful light has been shed. And this is why, by the end of my seminar, attendees understand so well why it is pointless to have a child examined by an ophthalmologist when an informed opinion about visual function as related to learning is the intent of the referral.

We understand the power of SI therapy as related to sensory processing disorders, and OTs understand the power of VT as related to vision disorders. For every pediatric ophthalmologist who tells parents that optometric vision therapy is a waste of time and money, we have 50 occupational therapists who set the record straight.  With each seminar that I do in NJ, that Dr. Fortenbacher does in Michigan, that Dr. Heying does in Iowa, that Dr. Morris does in Tennessee, that Drs. Appelbaum and Hillier and Hellerstein and Scheiman and Davis and many others do across the country, the truth will resonate exponentially.

– Leonard J. Press, O.D., FCOVD, FAAO

12 thoughts on “Occupational Therapy and Developmental Optometry Collaboration

    • Didn’t mean to leave you out, Tod, just used the names that popped into my head from personal experience! Have edited it to include you, and it would be my pleasure to include others who contact me. Speed of light is good!

    • Guess I was too cryptic for you, Michael. The picture goes together with the sentence: “That is why, when third parties look more closely at the fact that the AAP has joined ranks with the AAO in Policy Statements about optometric vision therapy, they can readily see that little meaningful light has been shed.” Make sense?

      • Len,
        Hope it makes sense to others. You have been doing a fantastic job with getting the word out to a wide range of practitioners and care givers.
        Stay healthy. (or clone yourself).

  1. Thanks, Michael. I appreciate the thought, and I am encouraged that through an increasingly wide array of forums, articles, books, and a social media, we will hit a tipping point where the public realizes the flip side of “If it’s too good to be true, it probably isn’t” when it comes to our critics, which is: “If it the criticism sounds absurd, it probably is”.

  2. I have a eight year old daughter who has sensory issues. Is it better to start sensory integration with an OT before doing any vision therapy with a developemental optomitrist or doesn’t it make any difference which therapy is undertaken first?

    • Great question, Michael. In your daughter’s case I would seek a developmental vision evaluation with an optometrist who has collaborated with SI OTs. They will be able to work out a relative value index. By that I mean the extent to which, if there are visual issues, she needs a better SI platform before focusing on vision – or vice-versa. In select cases we co-manage right from the start: one session per week in OT and one in VT. Realize as well as that VT is typically over a much shorter time frame than OT. It is rare for a child to be in OT for less than a year, and not uncommon for a child to be in VT for less than a year.

  3. An occupational therapist approached me last September because she was interested in learning more about vision therapy so that she could work with younger patients. The ophthalmologists in her hospital had no interest in helping. In October we hired her as our part-time therapist and have her come in once a week. We had a waiting list before we knew it and had to hire a COTA to work with her. Three of our first VT patients are about to graduate and have had remarkable success despite our OT’s somewhat limited knowledge of binocular vision which they have learned “on the fly”. The advantages include being able to utilize patients’ health insurance plans as well.

  4. 50 occupational therapist who set the record straight was really a cool things i ever heard,in Finland country where i see most of occupational therapist i can say that is really a very difficult job or task but then they still making it better.

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