The Interface Between Optometric Vision Therapy and Ophthalmology Revisited


In 2001 I attended a conference jointly sponsored by Jefferson Medical College and the Section on Ophthalmology of the American Academy of Pediatrics, during which time I had the serendipitous opportunity to speak from the podium to pediatric ophthalmologists and pediatricians about optometric vision therapy.  My experiences were detailed in a 2002 article in Binocular Vision & Strabismus Quarterly, reprinted in the Journal of Behavioral Optometry which you can view here.

Fast forward five years and the BV&SQ’s editor, Dr. Paul Romano, publishes an insightful letter to the editor from one of his own editorial board members, Dr. Jeffrey Cooper.  You can view Dr. Cooper’s letter in its entirety on page 17 of the third quarter 2007 issue here.  The letter is brilliant as related to the editor’s interest in the Story of Stereo Sue, and Dr. Romano has no reply other than to publish a note he wrote circling a news item regarding Optometric Push for Surgical Privileges in New Mexico.  The note (on page 18) reads:  “Jeff – What you & I think means little.  This is what really counts.  Best Personal Regards – Paul.”  In other words, as long as Organized Optometry is looking to expand its scope of practice, Organized Opthalmology will not acknowledge that there are areas of practice about which Optometry has unique knowledge or skill.  For a variety of reasons, the preferred target for ophthalmologic push-back toward optometry has been vision therapy, positioned and framed as unproven and scientific in an effort to cast doubt on the professionalism of the entire discipline at large.

Fast forward to the current issue of BV & SQ (3rd Quarter 2013), in which Dr. Romano published the following:

Evaluation of Binocular Vision Therapy Efficacy by 3D Video-Oculography Measurement of Binocular Alignment and Motility.  
Carlos Laria, M.D., PhD and David P. Piñero, PhD


The article demonstrates the efficacy of binocular vision therapy as applied to two patients with divergence excess, measured with 3D video-oculography.  The second patient also has an underacting R inferior oblique with 6^ right hyper.  The therapy procedures conducted included Hart Charts, Brock String, consciousness of physiological diplopia, accommodative facility with lens flippers, Apertrure Rule, vectograms, and vergence facility.  The outcome of these two cases is not particularly surprising to those who are experienced in optometric vision therapy, though the 3D VOG documentation adds a nice touch.


In his editorial that accompanies the article, Dr. Romano opines on the term “binocular alignment”, remarking:  Isn’t that what we strabologists and orthoptists all about?  We are alignment specialists, like front end workers on automobiles.  That is a very apt description, and something that Dr. Cooper addressed in his 2007 letter to the editor.  It is also what I emphasized in my 2001 appearance at the Section on Ophthalmology of the American Academy of Pediatrics.  In essence, MDs are the car mechanics and ODs are the driving instructors.  The division of labor between structure and function really is as basic as that, yet here we are almost 13 years later with very little progress in figuring out how our professions can work together in the best interests of the patient.  In part two I’ll have more to say abut this.

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