A Pediatrician’s View of Vision Therapy


zachary-kanin-a-hammerhead-shark-gets-his-eyesight-check-by-two-eye-doctors-in-either-co-new-yorker-cartoon

“MD’s have not been trained to think about vision. We have been trained to understand eyesight, or visual acuity, of each individual eye. Double vision is briefly discussed during neurology lectures, really in the context of new onset of double vision and evaluation for a stroke or brain tumor or some other new cause of double vision. Everyone knows that vision is important for learning, but vision processing – how the brain is interpreting what the two eyes are seeing together – was never discussed. The specific vision skills needed for reading – eye teaming, saccadic movements, pursuits, convergence in the same place – these were never mentioned during any of my training in medical school or residency. Ophthalmologists are trained to evaluate each individual eye, the visual acuity of that eye, whether or not disease is present, and if it needs surgery. They are not trained to evaluate how the brain processes the information coming in at the same time from both eyes together. I have had no training in ophthalmology, but I know this because a few months into vision therapy, I took Zach back to his ophthalmologist and discussed vision therapy with him. His response was, “I really haven’t been trained in this.” Then he went and got his ophthalmology text book and showed me what it says about vision therapy. It was not more than two or three sentences. I don’t remember exactly what it said, but it was something to the effect that there is no proven benefit. I have not read every study that the ophthalmologists did to determine if they believe vision therapy works or not. I did read a couple, though, and they were looking at visual acuity in each eye at 20 feet, having the patient do vision therapy, and then rechecking visual acuity in each eye at 20 feet. When they found no change, they concluded vision therapy did not work. I believe that if they understood what was really supposed to change and measured it, they would conclude that vision therapy does work.”

Zach1The quote above is from a phenomenal two-part interview of Janna Jannings, M.D., who is not only a pediatrician but a mother of a young boy who underwent vision therapy.  She credits vision therapy for literally saving his life.  It should be required reading for all parents, and would make informative reading for many professionals.  Zach’s story will be featured in Robin and Jillian Benoit forthcoming book, a follow-up to Jillian’s Story.

Dr. Jennings Interview Part 1.  Dr. Jennings Interview Part 2.

5 thoughts on “A Pediatrician’s View of Vision Therapy

  1. Dr. Jennings sent this clarifying comment to my Part 2 post; Posted by Janna Jennings, MD Feb 27, 2013 @ 3:49pm.

    “As I think back to medical school, I think it is inaccurate of me to have said that saccades, pursuits, and convergence were never mentioned. They were covered in neurology lectures, along with lots more information related to the brain. My choice of words should have been that the importance of these vision skills related to reading were not emphasized. MD’s, especially ophthalmogists, know what these eye movements are. But most of us just don’t understand their importance. I didn’t until 2 years ago.”

    • Thank you, Dr. Wittman. If you take a look at the Comments portion of this blog piece you’ll note a pediatric ophthalmologist asserting that he and his colleagues are developmental specialists, and that all ophthalmologists are neuroscientists. The essential problem as I see it is that these colleagues have bamboozled the AAP and the public in recycling the trash in their JPS every decade, discarding any critique of their position by Optometry, because they are the arbiters of what is relevant in visual development and neuroscience. PEDIG and CITT have been, in their own way, breaking down some of these barriers. But it will take courageous individuals such as Dr. Jennings, Dr. Walhof, and their pediatric colleagues to publicly call for accountability for the intentional mis-statements and mis-representations about VT by their colleagues. I applaud you for conducting the interview and posting it. I would add to Dr. Jennings’ clarification above that it wouldn’t be a terrible omission if medical students, residents and practitioners taught about vision skills such as saccades and convergence without emphasis on their relationship to reading. The problem is that they are led to believe (see the AAP/AAPOS JPS) that there is NO relationship between vision problems and reading other than a begruding “perhaps” related to CI. Even then, they discard evidence based medicine when it doesn’t suit their agenda to discredit VT, and insist that home VT with pencil push ups and/or a computer program can be an effective alternative to office based VT. As more MDs come out of the closet as Dr. Jennings and Dr. Walhof have done, other colleagues will be emboldened to say: ENOUGH. Developmental optometrists should be accorded due respect for their pioneering and ongoing contributions to the field of vision and learning. As you noted, it is time to end this disservice to children who would benefit from VT, but whose parents are dissuaded by their pediatrician.

  2. We need to work together. The pediatricians I know are all wonderful, caring people (we love ours!). The AAP statement was a step backwards, and it put the pediatricians in an awkward position. The AAP statement was a disservice to their members but especially to the children who would benefit from VT.

  3. Pediatricians send me lots of little patients and I love the kids. The kids and the pediatricians are as stated, wonderful people.
    Here we do not seem to have a problem except from the primary care physicians, and the nurses. One nurse mentioned to a patient of mine, “you need to see a real doctor.” She was told by our ophthalmologist to watch it.
    We all do the best we can, and refer when we need assistance. There is room for everybody, except the chain store problem we have.
    Len, by the way, we just picked up with our VEP a papilledema and sent the patient to the neurologist.
    August

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