Monroe “Puggy” Farmer – Part 5 (Final): Thinking Outside the Bag

Tonya is sitting in my office on Friday, as we continue our interview over a lunch break during the SUNY Residents’ Seminar.  As noted on our SCO website link, it’s important for us to discern that the Residency applicant understands the distinction between institutional and private practice residency experiences.

Interviews can be stressful, and I was impressed with the thought that Tonya had given to why she was applying to our Residency program.  Although no one should be as open as the gentleman above, Tonya was refreshingly forthcoming in noting that she had made application to several other private practice residencies, and two institutional residencies.  But what she told me next almost floored me.  She had decided not to interview at one of the institutions, because of that College of Optometry’s response to her inquiry.  In her cover letter she indicated interest in, among other things, vision-based learning problems and how vision influenced behavior and development.  The reply that she got was that she should seriously consider whether this program was a good fit because, essentially, they “don’t believe in that stuff”.

It was almost inconceivable to me that a College of Optometry faculty member would write that to an applicant.  To be fair to that program, I’ve not yet seen it in writing.  But is it possible?  Absolutely, and I found out why over the weekend.  I participate in an online forum regarding dyslexia.  Last night a dyslexia researcher who trivializes the role of vision cited an article in defense of her position.  It was published in Perspectives on Language and Literacy, a quarterly publication of the International Dyslexia Association, Winter edition 2011, co-authored by an optometrist from — you guessed it — the same College of Optometry that told Tonya they wouldn’t be a good fit for her Residency interests.

Here is what that article concluded:

“Given the evidence in this article and other reviews (American Academy of Pediatrics, 2009; Barrett, 2009), children with academic problems should be referred for vision exams using the same criteria as any other child. Visual acuity is critical for supporting reading, and people need to be able to see print sharply, clearly, and comfortably. However, routine screening for ‘vision-related learning problems’ is not warranted and would not be expected to have a major impact on the reading performance of children and adults with well-defined reading disabilities …. The fact that vision therapies (and therapies based on visual information processing) continue to proliferate despite decades of research reflects in part the degree to which parents are desperate to remediate reading problems.”

One might say it’s disappointing to see a College of Optometry faculty member put her name on an article that regurgitates the anti-VT bias of the American Academy of Pediatrics.  Indeed, as Dr. Fortenbacher and I have pointed out, the Section on Ophthalmology of the AAP doesn’t even follow the guidelines of the CITT study that office-based vision therapy is preferable to home based VT.  Nor, by the way, does this College of Optometry offer any office-based vision therapy, but that is a subject for another day.  On this day I will encourage Tonya to continue her vision quest.  Irrespective of where she does her Residency, I am confident that she will travel far on the path that Dr. Monroe “Puggy” Farmer put her on at age 6.  She is already a step ahead of the faculty member at a College of Optometry who dismissed the AOA’s Clinical Practice Guidelines on Care of the Patient with Learning Related Vision Problems out of hand.  She can think outside the bag.

– Leonard J. Press, O.D., FCOVD, FAAO


2 thoughts on “Monroe “Puggy” Farmer – Part 5 (Final): Thinking Outside the Bag

  1. Dr. Press,

    There is a tremendous grey area between dyslexia and LRVPs (or as I prefer, Visual Impediments to Learning, or VIL). Dyslexia is not a visual problem, but it is not the same neuropathology documented more than a hundred years ago. There is at the same time a very high correlation between dyslexia and visual dysfunction. Though this is not necessarily a causal relationship, leaving VILs alone while pursuing phonic-type training is the mark of a rank amateur. Not addressing them at all is an indication the therapist needs to broaden their understanding of basic human physiology and visual function in the classroom. At the same time, as there is no standard for assessing dyslexia, it is extraordinarily difficult to root it out, especially for clinical practitioners (education, psych, medicine) with a limited scope of assessment. It is quite possible for VILs to mimic dyslexia, and until VILs are identified any dyslexia treatment is unjustified and probably unfair to the child.

    My one beef with your post is that you did not identify the college of optometry. Either what you’ve described is the position of the faculty member, or that of the college. While not all colleges are behavioural schools, all colleges should at least recognize the importance of physiological optics and the resulting functional effects different visual ‘loads’ can have on a child, especially over prolonged periods. Not addressing these concerns didactically would point to a rather shallow understanding of what optometry really is and can be, as opposed to a Jr. ophthalmology college in which case the students would be better advised to pursue a Physician’s Assistant program for less money and with shorter time to completion. Behavioural practice is not hokus pokus or voodoo, it is the refinement of the application of theory in a thoughtful manner through careful observation and assessment of a person’s visual behaviour and needs. It is the thinking OD’s way of practicing, as opposed to simply regurgitating algorithms and ill-defined research as ‘practice’. I guess there’s a place for schools that ‘teach to the test’ instead of teaching to think, but one has to question the value of the education and the benefit to the profession that these schools provide.

    My son will soon be applying to optometry. He already knows that a complete optometric program of study includes solid coverage of behavioural concerns, whether he gets this in college, or afterwards in PE. For myself, a teacher and IT specialist coming into the profession late and as a OVT skeptic, the behavioural side is now the most important part of practice and I apply these principles to all cases, even those presenting as strictly medical concerns. As for in the classroom, I have come to believe that vision is so important in the early years, the lack of proper identification and management of VILs early is a leading contributor to social and economic inequality – VILs are especially ruthless in preventing academic advancement of North American First Nations/Aboriginals, Hispanics, and Blacks. To disregard the critical role of vision in early education is shameful and represents stunted thinking. No, OVT does not cure all learning and reading disabilities, but it does remove obstacles to learning in a great many cases thereby obviating the need for spurious assessment and intervention.

    Best regards,

    Dr. Boulet

  2. The only reason I didn’t mention the College of Optometry in question, nor post a reprint of the member of its faculty who co-authored the hatchet piece on vision therapy, is that my intent was not to embarrass a particular college of faculty member, but to point out how narrow a viewpoint it represents. Good luck to your son on his career path. I have a son who graduated five years ago, and there are few joys greater than seeing young ODs blossom in our field and our profession.

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