Osteopathic Physicians and Visual Somatic Dysfunction – Part 3


Here is the handout for the presentation by Dr. Dart to the American Academy of Osteopathy that I alluded to in Part 2:

Vision and the Primary Respiratory Mechanism.  I encourage you to read the handout, particularly from page 69 onward.  It will get your wheels turning.  While much of it may not be news to you, the fact that it is being presented by an osteopathic physician to his colleagues is food for thought.

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As an example, from page 69, under the heading of central vs. peripheral vision:

“Vision testing at the optometrist’s office evaluates our ability to see central detail, and the prescription that results is a prescription that provides optimal central visual acuity.

Corrective lenses are typically prescribed to give 20/20 central vision, getting a sharp focus of the image of distant objects on the surface of the fovea. This focuses the rest of the image, the peripheral fields of view, slightly behind the retina. Essentially, a prescription for myopia that provides sharpest central visual acuity over- corrects peripheral visual acuity.

But because our somatic reflexes act to optimize peripheral visual acuity, looking through the corrective lens that provides sharp central correction usually puts a patient into chronic somatic strain. In most cases, when a nearsighted person is looking through lenses that correct their central vision to 20/20, their cranial mech- anism will tend to move more deeply into extension and linger there, with reduced amplitude of motion into the flexion half of the cranial motion cycle.

This physical strain, which is palpable on physical examination of the cranial base and vault, tends to lengthen the A/P diameter of the skull and orbit. (It is inferred that this pattern of strain maximizes the length of the eyeball and therefore creates a sharper focus of image on the peripheral visual field.)

In consequence, most people who wear corrective lenses experience chronic visual somatic dysfunction. If you evaluate patients who wear glasses, you will find that this is a significant factor in reinforcing the chronicity of a great many of the somatic patterns that you are treating on a daily basis in your office.”

Dr. Dart presented again at the 2013 Annual Meeting of the Osteopathic Cranial Academy on June 22, giving a lecture and lab on cranial nerves III, IV, and VI from an ophthalmologic and osteopathic perspective.  Following him on the same program was our optometric colleague Dr. Rebecca Hutchins, addressing the effect of cranial trauma on vision.  Although there was no collaboration between the two presenters, Dr. Hutchins does indicate on her website that over the years she has frequently checked prescriptions with osteopaths and chiropractors, and that sensitive patients have found this to be an extremely helpful collaboration.

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As indicated in an article this year by Prevention, one in four medical students in the United States are now enrolled in a D.O. program, and their numbers are rising rapidly. In 1970 there were only 14,000 D.O.s in the U.S. but by next year there will be more than 100,000.  The article notes:

At the same time the number of DOs is rising, the already hazy lines between DO and MD are getting blurred further. Last year, the Accreditation Council for Graduate Medical Education announced a plan to merge the historically separate DO and MD residency programs into a single system. This means that by 2020 all doctors in the US, whether MD or DO, will finish their medical training under one umbrella. In a press release, Stephen Shannon, the president of the American Association of Colleges of Osteopathic Medicine, said that this approach “not only streamlines but strengthens the postdoctoral process, enhancing the ability of all physicians to learn the unique characteristics of osteopathic medical practice.”

The extent to which 2020 will bring a fusion between these two approaches remains to be seen, but there is no doubt that the potential for collaboration between D.O.s and O.D.s will continue to grow, particularly in the areas of developmental, behavioral, and neuro-rehabilitative care.

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