If VT Worked, Don’t You Think We’d Do It?


There has been a steady attrition in opposition to optometric vision therapy.  Perhaps it is because our field continually advances itself through the application of burgeoning knowledge about the interactions of the eyes and the rest of the brain and body.  Or because our network of collaborators in research and clinical practice casts an ever-widening net. Possibly it’s because patients and parents who benefit from optometric vision therapy are increasingly pleased about the outcomes.  Or could it be because social media makes it difficult to suppress the accumulated success stories that accrue every day of the week in our practices?

It is of course all of the above.  Which brings me to the question posed in our title – a comment that is on the wane but still comes up from time to time.  Parents unsure about whether or not to proceed with vision therapy sometimes turn toward their pediatrician for advice.  This typically results in referral to a pediatric ophthalmologist for a “second opinion”. (To wit, the AAPOS site contains the message that if vision therapy has been prescribed: “Finally, seek a second opinion from an ophthalmologist who has the experience in the care of children recommended by your pediatrician or primary care provider.”).  The irony is that parents are often puzzled about the second opinion they obtain, it’s usefulness akin to a consult with Dr. Vinnie Boombatz.


Let’s look at what parents historically have been told when they go for a second opinion, some of which I addressed in a previously published presentation (and that we’ve debunked through a number of prior commentaries, particularly the misinformation about CI):

  1. There’s no evidence that vision therapy works.
  2. There’s limited evidence that vision therapy works for CI.
  3. VT works for CI but it has nothing to do with learning.
  4. VT works for CI but it can be done entirely at home.
  5. VT works for CI but your child doesn’t have a problem.
  6. Stop making excuses for your child, and get more tutoring.
  7. If VT worked, don’t you think we’d do it here?

Addressing these issues through the years led me to draft responses that went into an OEPF pamphlet regarding Second Opinions About Vision Therapy.  It was opinion #7 that came to mind as I read Cameron’s Success Story above, completed by his mother.  Obviously parents are increasingly able to see through biases, and to value the specialized knowledge and skill required to deliver therapy services that can:

a) eliminate double vision and severe eyestrain

b) convert avoidance of reading to willingness or passion

c) transfer to activities beyond the classroom such as sports or driving

Cameron’s experience is not unique, by any means.  It’s a very similar odyssey that the American Academy of Optometry chronicled in Zach’s case, the centerpiece of this landmark position paper on Optometric Care of the Struggling Student.

So now that it has been eight years since the CITT has proven that office-based optometric vision therapy is significantly superior to home-alone therapy, Boombatzian logic should no longer reign.  Why actively dissuade patients from undertaking VT with the notion that “if it worked, don’t you think we’d offer it here?”

No need to answer; the question is rhetorical.  And the rhetoric implies that there is a significant price tag to offering optometric vision therapy, which includes maintaining efficient systems and well-trained staffs to render these services, and all the support functions necessary.  It is increasingly incompatible with the third party insurance “here’s my co-pay” nature of busy medical practice.  Rendering successful office-based optometric vision therapy is a challenge for which ophthalmologists weren’t trained, and that they wisely choose to avoid, and that is their prerogative.  But don’t you think they should let patients know that?

9 thoughts on “If VT Worked, Don’t You Think We’d Do It?

  1. In fact, ophthalmology did once ‘do VT’ but left it to the wayside when more profitable treatment modalities arose (a few hundred bucks for an injection, and 8 injections per hour instead of prolonged VT sessions at affordable rates for parents). Now of course, orthoptics works under the purview of ophthalmology where it has floundered ever since it was subsumed in this way. And oh, btw, if strab surgery worked, I’m sure more VTOD’s would recommend it, too.

  2. Seeing is believing. I have limited my practice to vision therapy for over thirty years. During that time, with my own eyes, I have seen thousands of children benefit, no longer suffering from eyestrain and double or blurred vision. Social media allows others to see parent’s tell the stories of their children’s successes. As more people see, more more people believe. No one who has seen for his or her self believes the stories of doctors who have not seen. This is the reason that occupational therapists routinely refer rather than listen to ophthalmologists. They have seen the changes that vision therapy has make in their patients. Seeing is believing. Not seeing—we call that blindness.

    • Well-expressed, Dr Cook. Early in my career, around the time we first met and had the privilege of working together, the Chief Medical Office of Philadelphia wrote in the introduction to the city’s vision screening manual: “One misses more by not looking than by not seeing”. So while I agree that not seeing is a major problem, I suspect there are far more ophthalmologists and pediatricians who are simply not looking. To add to your points, invariably when there is an honest difference in opinion, the parent will increasingly say these days: “I’m not even sure how they arrived at the decision that my child doesn’t need vision therapy, because they only did about 10% of the testing that you did.” That’s what I mean by not looking.

  3. Regarding ‘steady attrition”: there are many levels of VT, and some are more compatible with traditional orthoptic thinking than others. As a Ped MD practicing with 3 ICO-trained pediatric ODs (2 current ICO faculty members), collaboration has been successfully facilitated by emphasizing common ground. I try not to step on their toes, and to celebrate their successes. They try not to rub in recurrent postoperative strabismus too much.

    Regarding “If VT worked, don’t you think we’d do it?”: as mentioned above, there are many levels of VT, and many MDs do include some of them in practice. As MD-OD relations improve, and as outside forces influence what we do, cooperation will gradually erode some of the previous generation’s turf battles. In our practice, I routinely offer 2nd opinions from our ODs to interested parents; similarly, I receive surgical referrals from them for appropriate patients.

    Regarding “missing more by not looking”: That’s a truism. (As is, “When all you have is a hammer, everything starts to look like a nail.”) (Or, “there are many ways to skin a cat.”)

    Regarding the pecuniary realities of 21st century vision care in the US: These are not unique to ophthalmologists, ODs, or other healthcare providers. Control of much of healthcare’s monetary aspects has transitioned away from the doctors and patients. Everyone of necessity seeks a balance between effectiveness, efficiency, and profitability. Financial ethics are assumed, but as we know, it doesn’t hurt to get a refresher. Nonetheless, it’s probably best not to categorically project unsavory motives on anyone, regardless of training.

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