Our Resident, Dr. Chris Lehman, is going through a very interesting experience with one of our patients having a primary diagnosis revolving around accommodative issues. His father, who brings his son for each therapy session, wants to be sure that we are “only working on focusing and not eye muscle problems”. He is fond of mentioning that he is a scientist, and in our practice we refer to this as “The S Factor”.
I believe I know why the child’s father is making these demands, and I know that he has his child’s best interests at heart, but how would you handle this type of request? Clearly you could point out to the child’s father than accommodation and vergence are intimately intertwined. In fact neurologically they are synkinetically linked and therefore from a scientific perspective it would be illogical if not counterproductive to work on one system while leaving the other to chance. You could back that up with a simplified plant diagram showing dual controller interaction between accommodation and vergence.
Or … you could simply acknowledge Dad’s perspective and highlight all the accommodative aspects of therapy in which his son is engaged. Aside from procedures that are accommodative in nature by use of lenses, varying distance and size of stimuli, most of our procedures naturally involve accommodative accuracy, stability, efficiency, and flexibility by the nature of their attentional and cognitive control. Remember: vision is in the brain of the beholder.
By the way, where do you think Dad is getting his overly reductionist approach from? Why the aversion to any work on eye muscles? We know that if one does research, convergence insufficiency is the most common diagnosis associated with VT. And although we can’t be sure, one possibility is that Dad was exposed to the myth that convergence insufficiency is over-diagnosed and he’s therefore leery of work on eye muscles.
You mean you haven’t heard that one yet? Well believe it or not, there are “experts” making that claim.
In the book I introduced in Part 1 that was the our portal to reductionist thinking, the subtitle is “Bridging the Two Cultures”. Although Dr. Kandel used painting as an art form to probe reductionist thinking in vision, the overarching theme is that any science is imbued with art and vice-versa.
Our staff repeatedly hears me ask them regarding patients during our weekly case conferences: “Why is the patient here?” “How will they judge success in therapy?” That remains a vital bridge between the art and science of optometric vision therapy.