The Interface Between Optometric Vision Therapy and Ophthalmology – Part 3

We finished Part 2 with citations from a book published in 2008, based on a meeting held in 2007 under the auspices of Case Western Reserve University to celebrate the contributions of Louis Dell’Osso, well known for his work in ocular motility.  The book was co-edited by R. John Leigh, co-author of the most definitive book on The Neurology of Eye Movements and contributor to oculomotor integration theory.  The point we’ve underscored is that the interface between optometric VT and ophthalmology lies just as much if not more at the crossroads of neurology than it does at the level of pediatric ophthalmology and pediatrics.  

adult-vision-therapy-ballThis in part is why we are fond of describing vision therapy as physical therapy with a cognitive component.  It is this latter feature that most ophthalmologists struggle with.  After all, if one is comfortable dissociating eyes from brain, then cognition can be artificially parsed out of the equation.  Not so if one accepts the concept of emotional vision.  While undertaking vision therapy procedures, what the patient is thinking and feeling is intimately linked with with is being seen.  Consider, for example, this recent perspective from Nature Reviews Neuroscience:   “Instead, we propose that the primary role of the amygdala in visual processing, like that of the pulvinar, is to coordinate the function of cortical networks during evaluation of the biological significance of affective visual stimuli. Under this revised framework, the cortex has a more important role in emotion processing than is traditionally assumed.”

We recently had an adult patient in vision therapy who experienced consecutive esotropia.  This is a condition in which the patient’s left eye originally drifted outward excessively, but following surgery is now constantly misaligned inward.  The patient complained to the surgeon that she was now experiencing periodic double vision when looking straight ahead, especially when fatigued or stressed, and constant double vision when she looked leftward.  When she specifically asked about undertaking optometric vision therapy, the ophthalmologist advised the patient not to undertake optometric vision therapy, but to simply practice moving the left eye to the left at least 100 times per day.  I’m not kidding you.  (And my next thought was, where is the “evidence based medicine” that this works?)


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