Tuesday, April 3, 2012

Optometric Vision Therapy: Answering those Questions

 My friend and colleague, Dr. Len Press wrote an article some time ago where he discussed the interplay between optometry and ophthalmology when it comes to optometric vision therapy and ophthalmology's seemingly inability (my phrasing not his) to understand optometric vision therapy and the role it plays in patients' lives. Here are some of the questions discussed ....with the always well thought out answers by Dr. Press .I've added a few links below as well. DM
Where is the scientific basis for Optometric Vision Therapy?
As mentioned, Dr. Cooper’s scholarly article provides references that clearly
substantiate the scientific basis of vision therapy. Clinical Practice Guidelines
are available from the American Optometric Association on the Care of
the Patient with Learning Related Vision Problems, Accommodative and
Vergence Dysfunction, Amblyopia, and Strabismus. Each of these has references
incorporating scientific method. The research presented is commensurate with clinical research
in fields such as occupational therapy, and is equal to or better than research
traditionally presented for clinical methods in pediatric ophthalmology.

[ I would also add the outstanding article by Dr. Kenneth Ciuffreda's article:The scientific basis for and efficacy of optometric vision therapy in nonstrabismic accommodative and vergence disorders.]

How do optometrists know which patients might benefit from vision therapy?
The Four Clinical Practice Guidelines from the AOA mentioned above provide
clear guidelines for differential diagnoses. Textbooks referenced in this
article, in addition to others available, provide this as well.

[AOA Guidelines: Pediatric Eye And Vision ExaminationCare of the Patient with Amblyopia, Care of the Patient with Strabismus, Care of the Patient with Accommodative and Vergence Dysfunctions, Care of the Patient with Learning Related Vision Problems.]

Is it true that vision therapy patients are “in for life?”
Nothing could be further from the truth. The clinical practice guidelines above,
in addition to guidelines issued by the College of Optometrists in Vision Development
(COVD) based on ICD codes for various conditions, are proof that this is not the case.

How might I judge if a patient is in need of vision therapy, or if a person I am referring the patient to is a credible provider?
All optometrists receive graduate education in and are licensed to practice vision
therapy. The Optometric Extension Program (OEP) provides
post-graduate education in the areas encompassing vision therapy. The Collegeof Optometrists in Vision Development (COVD) provides a board
certification process, and has a national directory of providers. The American

Academy of Optometry (AAO) has a diplomate program in binocular vision
and perception as well as in pediatric optometry.

Why is vision therapy so expensive?
It is intriguing that physicians don’t ask the same questions regarding the expense,
scientific underpinnings, and pertinence to learning of occupational
therapy, which they endorse far less critically, despite the obvious parallels
between the two fields. To answer the question directly, the fees for vision
therapy services are commensurate with other therapy procedures involving
similar bodies of knowledge and time expended. Aside from the doctor’s
time in evaluating the patient, there are often prior reports to read that
are pertinent to decisions about optometric intervention, time spent
programming and sequencing activities to strike an effective balance between
office and home therapy, and time spent with therapists to discuss ongoing

Why does vision therapy work when it does? Eye problems shouldn’t have anything to do with LD or ADD since these are CNS or brain problems.
The retina is brain tissue. Dissociating the role of the eye in visual processing
from brain function is an artificial distinction. With regard to learning and
attention systems, principles of cognitive neuroscience substantiate that interventions
directed toward sensory and motor eye functions have a salutary
and pervasive effect on central processes of the brain.

[A paper by pediatric ophthalmologist Dr. David Granet, disputes the claims that ADD and vision are not related. He notes that "...We report an apparent three-fold greater incidence of ADHD among patients with CI when compared with the incidence of ADHD in the general US population (1.8-3.3%). We also note a seeming three-fold greater incidence of CI in the ADHD population...."]

For additional information on vision, vision and learning and optometric vision therapy go to:

Position Papers and Joint Organizational Policy Statements
Optometry & Vision Development Journal
Research Update on Visually-Based Reading Disability
Randomized Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children

Research on Vision Therapy

1 comment:

  1. Thank you for posting this and a link to the article. I had lost my photocopy of the article from the journal Strabismus and Eye Muscle Surgery Quarterly - which I had to travel hundreds of miles from Vancouver BC to Forrest Grove, Orgeon to find. Believe it or not, the article is not available in any library between Vancouver and Forest Grove!

    Needless to say, I had no idea that it was also published in the COVD Journal and available online at the the COVD website! Anyway, thanks again - it is an article that I like to share with patients and just to read once in a while like favorite book.

    Dr. Randhawa


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