DIAGNOSIS, DOCTORS, CONTROVERSY
A recent report from Canada thoroughly examined the efficacy of vision therapy and found an apparent research war over its use. Optometrists stated adamantly that vision therapy was good practice; ophthalmologists were equally strong in their statements against it.
Interestingly, vision therapy traces its origins back to an ophthalmologist from the late 19th century named Dr. Javal. He pioneered strabismus treatment with orthoptics and later a Dr. Valk, another ophthalmologist, expanded his work in 1904. Vision therapy continued to advance by the work of many ophthalmologists and optometrists until the late 1980's and early 1990's. During the period of the late 1960's to the 1990's, ophthalmologists' attitudes changed towards vision therapy and they began publishing papers opposing vision therapy. This change in attitude seems to be an aggregation of a failed perceptuo-motor remediation program called the Frostig Program which was a pseudo-vision therapy method carried out by educators, and a series of publications on behavioral vision therapy by optometrist Dr. Skeffington. The publication came into question when its postulations failed to meet the ophthalmologists' experimental design standards. Regardless, a recent survey by "Binocular Vision and Eye Muscle Surgery Quarterly" interviewing pediatric and stabismological ophthalmologists found that 64 percent of American doctors and 85 percent of international doctors recommend using vision therapy before surgery. The author speculated that there were three reasons for the differences between the views of U.S. and international ophthalmologists. They were:
- Insurance companies outside the U.S. do not compensate for eye muscle surgery as well as they do in the U.S.
- U.S. surgeons do not get the same fee for orthoptic treatment as they do for surgery.
- Surgeons may be reluctant to administer orthoptics and reluctant to send patients elsewhere to get treatment.
The fact that optometrists, ophthalmologists, and educators use different definitions for describing treatments and therapies continues to exacerbate the divide. Certainly there exist many criticisms of vision therapy. But to be clear, the majority of these criticisms arise from a lack of universal definition of disorders, defined experimental methods and methodology, and conflicting professional interests.
BREAKING THROUGH THE FOG
Controversy aside, vision therapy is a proven method and logical vanguard approach to patient care. As stated earlier, the necessity of universal definitions and agreed upon methodology is important groundwork that still has yet to be done. Until the time comes when that happens and doctors can put aside non-care related issues, most patients will not have a vision therapy option. Over one hundred years ago, Dr. Javal created the first vision therapy techniques and they have been advancing with more effectiveness and sophistication ever since. Modern brain imaging techniques are telling researchers that more and more disorders are linked to the visual system. With this new evidence it appears that once again vision therapy has a bright future.
This was the final of four articles in a series on the Vision Therapy Opportunity by Erich W. Mack.
Erich Mack, B.S., ABO, NCLE, is a certified Arizona licensed optician. At Visions Optique, he assists in practice management, training and brings his personal style to everyday opticianry and vision therapy responsibilities as well as creating new CE courses.
