More Scientific Proof for VT, sorry OMDs

[IndianaOD]

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Many OMDs have vehemently bashed and ridiculed Optometric vision therapy and its effectiveness. ODs practicing VT know it works and see the changes in people's lives. This is yet further evidence that the stuff works and deserves consideration.

Best Treatment Determined for Childhood Eye Problem

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..Medical News
Keywords
CONVERGENCE INSUFFICIENCY, OPHTHALMOLOGY, PEDIATRICS


Description
Mayo Clinic researchers, as part of a nine-site study, helped discover the best of three currently-used treatments for convergence insufficiency in children. Convergence refers to the natural ability of the eyes to focus and align while viewing objects up close. Children with convergence insufficiency tend to have blurred or double vision or headaches and corresponding issues in reading and concentrating, which ultimately impact learning.

Newswise * Mayo Clinic researchers, as part of a nine-site study, helped discover the best of three currently-used treatments for convergence insufficiency in children. Convergence refers to the natural ability of the eyes to focus and align while viewing objects up close. Children with convergence insufficiency tend to have blurred or double vision or headaches and corresponding issues in reading and concentrating, which ultimately impact learning. The findings, published today in the journal Archives of Ophthalmology (http://archopht.ama-assn.org/ ), show children improve faster with structured therapy sessions in a doctor's office, with reinforcement eye exercises at home.

"This is good news for children and parents experiencing this fairly common condition," says Brian Mohney, M.D., Mayo Clinic ophthalmologist and lead investigator for Mayo in the study. "Three different approaches were being used across the country and no one knew for certain which worked best. Now that's settled. And only 12 weeks of treatment were necessary to demonstrate improvement."

How they did it.

The researchers followed 221 children nationally, ages 9 to 17, divided into four study groups, two of which received only home-based therapies. One group did simple daily exercises for 15 minutes, trying to focus on a moving pencil. A second home-based group performed a shorter version of the pencil exercise and a series of computer-based exercises using special software. A third group did an hour of supervised therapy in a clinical office each week along with 15 minutes of prescribed exercises at home five days a week. The fourth group, the placebo or control group, did office and home exercises designed to look like real therapy but that had no effect. Follow-up exams were held after the fourth and eighth weeks and at the end of the 12-week study.

Significance of the findings

Children in all three treatment groups experienced improvement, though it's not clear from the research whether any improvement in the home groups was due to a placebo effect. About 75 percent of the children who had weekly office-based therapy coupled with 15 minutes of at-home exercise five days a week experienced either normalization (full correction) of their vision in 12 weeks or saw marked improvements, compared to roughly 40 percent in the two home treatment groups. Researchers say that the lower cost of home therapy may be a factor in its popularity, but they point to the high percentage of normalized vision in the office-based sample after 12 weeks as an indicator of quality outcome in the shortest period of time.

The National Eye Institute, part of the National Institutes of Health, sponsored the study. Others involved in the research from Mayo Clinic were Jonathan Holmes, M.D.; Melissa Rice, O.D.; Virginia Karlsson; Becky Nielsen; Jan Sease; and Tracee Shevlin.

.

 

[Olddog1]

Nice to see a prospective, randomized clinical trial for vision therapy. However, before you go crowing how this is the cat's meow, a few points. The study was done for CI. If you were going to do a study for something that VT might work for, this was it (not such good results with those congenital esotropes; 2 yo aren't real good at computer stuff but mom and dad are sufficiently warned about the blinding ramifications of strabismus surgery, but I digress). I will say bravo for a well done study. There was a statistically significant difference between the home vs office VT group. However, adherence to the home protocol was based on home logs and telephone interviews. I wonder how the incidence of cavities would correlate to telephone interviews with parents of 9 to 17 year olds with regard to tooth brushing. It would be nice to have seen another group with the parents having had a 1 hour orientation to the computer program and have them sit and monitor the child for the 15 minutes a day they were to utilize the home therapy.

This study definitely lends credence to VT, however, while the patients exhibited an improvement of symptoms and measures of near point convergence at 12 weeks, is this clinically significant? Also, with the stock market dropping like a rock and everyone watching where each dollar goes does the time and money spent in the office performing VF outweigh buying the $40 computer program for the home? Would a cohort of anal, observant parents have skewed the study to home therapy or at least made is just as efficacious as office therapy? We don't know as this was not an endpoint for the study. The authors even say in their own discussion that 12 weeks may not be enough time to see improvement with the less rigorous home protocol. Lastly, the treatment groups were NOT equal. The office group had a 60 minute in office session per week and then 15 minutes at home 5 days a week. The home base group did 5 minutes of pencil pushups (shown by this very study to be the same as placebo) a day and then the 15 minutes of home based therapy 5 days a week. Instead of pencil pushups if mom or dad had held Jr's hand for an hour with instructions of how to do the computer program would they have had similar results as well?

Maybe next time before you title your post "More Scientific Proof for VT, sorry OMDs " you could spend some time reading the article. To everyone else you can download the article for free (as of now) it is interesting, even for those of us who see kids <1% of the time.

 

[IndianaOD]

Nice to see a prospective, randomized clinical trial for vision therapy. However, before you go crowing how this is the cat's meow, a few points. The study was done for CI. If you were going to do a study for something that VT might work for, this was it (not such good results with those congenital esotropes; 2 yo aren't real good at computer stuff but mom and dad are sufficiently warned about the blinding ramifications of strabismus surgery, but I digress). I will say bravo for a well done study. There was a statistically significant difference between the home vs office VT group. However, adherence to the home protocol was based on home logs and telephone interviews. I wonder how the incidence of cavities would correlate to telephone interviews with parents of 9 to 17 year olds with regard to tooth brushing. It would be nice to have seen another group with the parents having had a 1 hour orientation to the computer program and have them sit and monitor the child for the 15 minutes a day they were to utilize the home therapy.

This study definitely lends credence to VT, however, while the patients exhibited an improvement of symptoms and measures of near point convergence at 12 weeks, is this clinically significant? Also, with the stock market dropping like a rock and everyone watching where each dollar goes does the time and money spent in the office performing VF outweigh buying the $40 computer program for the home? Would a cohort of anal, observant parents have skewed the study to home therapy or at least made is just as efficacious as office therapy? We don't know as this was not an endpoint for the study. The authors even say in their own discussion that 12 weeks may not be enough time to see improvement with the less rigorous home protocol. Lastly, the treatment groups were NOT equal. The office group had a 60 minute in office session per week and then 15 minutes at home 5 days a week. The home base group did 5 minutes of pencil pushups (shown by this very study to be the same as placebo) a day and then the 15 minutes of home based therapy 5 days a week. Instead of pencil pushups if mom or dad had held Jr's hand for an hour with instructions of how to do the computer program would they have had similar results as well?

Maybe next time before you title your post "More Scientific Proof for VT, sorry OMDs " you could spend some time reading the article. To everyone else you can download the article for free (as of now) it is interesting, even for those of us who see kids <1% of the time.

Its more proof I said. Umm I did read the article, thanks. If you want the big CI studies look up the CITT stuff. If you do some research you can find many articles on superior results of VT vs surgery for many strabismics. Obviously, the rarer congenital cases are different.

I say sorry OMDs because if you talk to them they think its all voodoo and disrespect ODs all the time. Thing is they are having to admit its legitamite. I'm a pretty young OD still, but cannot count how many people I have helped that have been passed over by OMDs.

 

[SaveYourself]

VT is one of the reasons OD's are grouped with chiropractic. If optometrists ever want respect, the profession needs to stop doing stuff for the cash and get the practices out of the shopping malls, Walmarts and Costcos. Practice medical eyecare that actually does something for your patient rather than just taking their money and giving them a binocular flipper or popscicle stick to play with. Every single VT "success story" never states the downside. What happens to those patients 5 years down the road if they stop their exercises? They go right back to where they were. VT cures nothing. It simply pads the bank accounts of a profession that is getting crushed by retail conglomerates.

 

[IndianaOD]

VT is one of the reasons OD's are grouped with chiropractic. If optometrists ever want respect, the profession needs to stop doing stuff for the cash and get the practices out of the shopping malls, Walmarts and Costcos. Practice medical eyecare that actually does something for your patient rather than just taking their money and giving them a binocular flipper or popscicle stick to play with. Every single VT "success story" never states the downside. What happens to those patients 5 years down the road if they stop their exercises? They go right back to where they were. VT cures nothing. It simply pads the bank accounts of a profession that is getting crushed by retail conglomerates.

Seriously? I am sorry but this post reeks of ignorance concerning real VT. I actually lose money on VT at this time.

 

[SaveYourself]

Yes, seriously. How can anyone in practice lose money dedicating 20 minutes to a patient that is PAYING PRIVATELY and has to purchase their flipper, string with beads and other aids? I've seen practices that charge 45-50 for a binocular flipper, 20 for string with beads, and don't even ask me to tell you what they were charging for vectograms! Then it's a short 10 minute appointment to work with the person and collect that private payment. And just like chiropractic, it's repetitive. Keep the patient coming back with promises of getting a 20 diopter exotrope to be able to converge like a regular person. Then they lay off the excercises, go back to where they were and mom and dad are still paying for the visits. Disgusting...

I remember something called, "The See Clearly Method" that made promises to presbyopes as well. It's not around anymore, because it was sued into annihilation.

I guess you could say I'm not really a fan of VT...

 

[IndianaOD]

Yes, seriously. How can anyone in practice lose money dedicating 20 minutes to a patient that is PAYING PRIVATELY and has to purchase their flipper, string with beads and other aids? I've seen practices that charge 45-50 for a binocular flipper, 20 for string with beads, and don't even ask me to tell you what they were charging for vectograms! Then it's a short 10 minute appointment to work with the person and collect that private payment. And just like chiropractic, it's repetitive. Keep the patient coming back with promises of getting a 20 diopter exotrope to be able to converge like a regular person. Then they lay off the excercises, go back to where they were and mom and dad are still paying for the visits. Disgusting...

I remember something called, "The See Clearly Method" that made promises to presbyopes as well. It's not around anymore, because it was sued into annihilation.

I guess you could say I'm not really a fan of VT...

Sounds like you been around some greedy VT dabblers. I do it because I like it and I see it make a difference. Honestly the practice doesn't even break even when I see VT patients.

 

[4Eyes]

There is more than one camp when it comes to VT. Some are into the evidence-based, some don't care as much about that. It is the latter that causes problems with the medical community, and I'm not so much a fan of that either (*cough*OEP*cough*). My thinking is, to quote a dumb phrase: don't throw the baby out with the bath water.

It seems that the VT education is the one thing that varies the most among schools.

Interesting article.

 

[Oculomotor]

I've seen practices that charge 45-50 for a binocular flipper, 20 for string with beads, and don't even ask me to tell you what they were charging for vectograms!

How is that different then me going to get a physical and having a PA do a "crappy" less than thorough physical and then I had to pay $100.00 for it!??

Gimme a binocular flipper, and a string with beads any day!

 

[VA Hopeful Dr]

I've seen practices that charge 45-50 for a binocular flipper, 20 for string with beads, and don't even ask me to tell you what they were charging for vectograms!

How is that different then me going to get a physical and having a PA do a "crappy" less than thorough physical and then I had to pay $100.00 for it!??

Gimme a binocular flipper, and a string with beads any day!

Aren't you the guy that gets angry when MDs assume that ODs aren't as good as ophtho?

 

[Oculomotor]

VA,


Please don't make the analogy that an Ophthalmologist to an Optometrist is the same as an Physician to a PA....that is ridiculous.....A PA (as valuable as they are) is a SUPERVISED health care practitioner, SUPERVISED prescriber, EVERYTHING they do has to signed -off on the chart (whether the supervision is on-site, off-site, or direct). They are not a prescriber in the independent-autonomous practitioner sense of the word. An optometrist is an Independent Doctorate Level Prescriber/Limited License Practitioner analogous to a Dentist (same amount of training) or a Podiatrist (until most recently--now they require 2-4 yr residency.) We have 100% liability for what we do just like an MD or DO! A PA or nurse practitioner does not! (although they are being sued more often now according to a close friend of mine who is a trial lawyer!) I have every state's Optometry laws, Dentistry laws, PA laws, among other health care professionals, at home and if you want to discuss it by PM we can. Maybe I shouldn't have used the word "crappy"---I digress. But please do not insult me as (after I got a B.S.) I am taking 22-24 semester hours for 4 yrs to get a Professional Doctorate (O.D.) and then undertake a 13 month residency to work in a "small area" of medicine---the eye. Ophthalmologists and Optometrists are Eye Doctors. A Physician is a doctor and a PA is a Supervised Advanced Practice Clinician. If I go to a physician for care I expect the PHYSICIAN to see me. If I go to an optometrist or ophthalmologist I DEMAND that the OD or OMD do my refraction and eye health check...not a tech......

VA you really disappoint me sometimes as I feel you bash optometry in a very subtle way and other times you support it. What gives?

 

[VA Hopeful Dr]

VA,


Please don't make the analogy that an Ophthalmologist to an Optometrist is the same as an Physician to a PA....that is ridiculous.....A PA (as valuable as they are) is a SUPERVISED health care practitioner, SUPERVISED prescriber, EVERYTHING they do has to signed -off on the chart (whether the supervision is on-site, off-site, or direct). They are not a prescriber in the independent-autonomous practitioner sense of the word. An optometrist is an Independent Doctorate Level Prescriber/Limited License Practitioner analogous to a Dentist (same amount of training) or a Podiatrist (until most recently--now they require 2-4 yr residency.) We have 100% liability for what we do just like an MD or DO! A PA or nurse practitioner does not! (although they are being sued more often now according to a close friend of mine who is a trial lawyer!) I have every state's Optometry laws, Dentistry laws, PA laws, among other health care professionals, at home and if you want to discuss it by PM we can. Maybe I shouldn't have used the word "crappy"---I digress. But please do not insult me as (after I got a B.S.) I am taking 22-24 semester hours for 4 yrs to get a Professional Doctorate (O.D.) and then undertake a 13 month residency to work in a "small area" of medicine---the eye. Ophthalmologists and Optometrists are Eye Doctors. A Physician is a doctor and a PA is a Supervised Advanced Practice Clinician. If I go to a physician for care I expect the PHYSICIAN to see me. If I go to an optometrist or ophthalmologist I DEMAND that the OD or OMD do my refraction and eye health check...not a tech......

VA you really disappoint me sometimes as I feel you bash optometry in a very subtle way and other times you support it. What gives?

I wasn't insulting optometry, I was pointing out your disdain at another profession that has its own important role in the same way that MDs sometimes think of ODs. Its not a perfect analogy, but the idea behind it is similar.

I think I'm fairly consistent in my support for optometry. What I don't support is the lack of sense I see here at times. My biggest peeve runs along with KHE. You folks have many better things to try and fix than MD opinion of you. Insurance equality, vision plans, scope (for the states where this is an issue), and so on. Were I an OD I'd much rather concentrate on getting paid well for what I already do than trying to get things I legally can't. That being said, I would make an exception if your state doesn't even have full rights to topicals, but its my understanding that most do have that.

Even though I will never practice it, I really do wish optometry well - too much personal history to think otherwise. It just frustrates me to see so many ODs concentrating on what, to me, seems like things that shouldn't be a top priority.

 

[aphistis]

I've seen practices that charge 45-50 for a binocular flipper, 20 for string with beads, and don't even ask me to tell you what they were charging for vectograms!

How is that different then me going to get a physical and having a PA do a "crappy" less than thorough physical and then I had to pay $100.00 for it!??

Gimme a binocular flipper, and a string with beads any day!

It must be hard to evaluate the quality of a physical examination when you've never been taught to do one yourself.

 

[Oculomotor]

Aphistis jumping to conclusions again.....Actually in my health education background (another health care professional program) I have been taught how to do a "physical" exam. So before you make a comment you might want to "ask" me! LOL 👍😀

And I am sure as a "Dentist" you were taught to do a bunch of full body physical exams in Dental School. (rolling my eyes)

Now maybe as a resident in OMFS you definitely would have to "really" know but not as a dental student or general dentist.

 

[Oculomotor]

Actually VA I really don't care about MD opinions----opinions are like *******s and everybody has one. I know it is about business----Ophthalmologists will want my referrals and they will be cordial to get them. Plain and simple. What the Hubris laiden medical community thinks of my degree doesn't change the fact that I am going to be an eye doctor. Actually where I will be practicing my family name is entrenched in medicine so I will be in a good situation "perceptually." If I was done now I would have a lot of referrals and a good name.....no worries for me...just get the degree! 🙂

 

[eyestrain]

Aphistis jumping to conclusions again.....Actually in my health education background (another health care professional program) I have been taught how to do a "physical" exam. So before you make a comment you might want to "ask" me! LOL 👍😀

I figured this was coming.

And I am sure as a "Dentist" you were taught to do a bunch of full body physical exams in Dental School. (rolling my eyes)

I don't think he said he was doing physical exams, so let's tone it down a little. Also, why the quotations around the word dentist?

 

[eyestrain]

What the Hubris laiden medical community thinks of my degree doesn't change the fact that I am going to be an eye doctor.

Again, you calling out the hubris of the medical community is about the worst case of the pot calling the kettle black that I've ever seen. Hubris seems to be about all you're capable of.

 

[VA Hopeful Dr]

Actually VA I really don't care about MD opinions----opinions are like *******s and everybody has one. I know it is about business----Ophthalmologists will want my referrals and they will be cordial to get them. Plain and simple. What the Hubris laiden medical community thinks of my degree doesn't change the fact that I am going to be an eye doctor. Actually where I will be practicing my family name is entrenched in medicine so I will be in a good situation "perceptually." If I was done now I would have a lot of referrals and a good name.....no worries for me...just get the degree! 🙂

You're agreeing with me here. I don't think you should care what we think of you. You're also right about MDs being nice to get your surgery patients, that's nothing new.

As a side note, I do grow weary of all the MD arrogance comments running through here. Most of us aren't that bad, you just hear the vocal ones because the rest of us are quietly doing our jobs.

 

[Oculomotor]

Eyestrain,

You really need to just stop while you are behind. I COME FROM A MEDICAL FAMILY! DO YOU UNDERSTAND THAT? I have 15 Medical Doctors in my "Extended Family" (including my parents). I grew up around medicine my entire life----I know about professional hubris. So please stop making comments when you have no adequate frame fo reference on me. Do you know my life experience? You base your analysis "Dr" on the little bytes of commentary on this ridicoulous site? I hate to tell you this Mr/Mrs/Ms people say plenty of things on here they will not say int he real world!
There are plenty of MD's who are WONDERFUL people---I know quite a few of them. I am talking about the outspoken types that think that you as an OD are dirt and a MD-wannabe. When I refer to medical hubris I am talking about the "bad apples" and not EVERYONE!


SO PLEASE STOP 😉

 

[Oculomotor]

"You're agreeing with me here. I don't think you should care what we think of you. You're also right about MDs being nice to get your surgery patients, that's nothing new.

As a side note, I do grow weary of all the MD arrogance comments running through here. Most of us aren't that bad, you just hear the vocal ones because the rest of us are quietly doing our jobs. "


I agree with you VA.........👍

 

[eyestrain]

Eyestrain,

You really need to just stop while you are behind. I COME FROM A MEDICAL FAMILY! DO YOU UNDERSTAND THAT? I have 15 Medical Doctors in my "Extended Family" (including my parents). I grew up around medicine my entire life----I know about professional hubris. So please stop making comments when you have no adequate frame fo reference on me. Do you know my life experience? You base your analysis "Dr" on the little bytes of commentary on this ridicoulous site? I hate to tell you this Mr/Mrs/Ms people say plenty of things on here they will not say int he real world!
There are plenty of MD's who are WONDERFUL people---I know quite a few of them. I am talking about the outspoken types that think that you as an OD are dirt and a MD-wannabe. When I refer to medical hubris I am talking about the "bad apples" and not EVERYONE!


SO PLEASE STOP 😉

Listen, I could care less about your illustrious physician-filled family. You missed my point entirely. You consistently bring up the hubris of the medical community, yet you are not capable of recognizing your own short-comings in that area.

And about me "basing my analysis on little bytes from this site", tell me, what else do I have to base my analysis of you on? The majority of your posts consist of ranting and raving about one thing or another, using lots of bold and capital letters to try to get across whatever point you think you have. You only manage to stir up **** and rarely add anything of substance to any discussion. Until you do something to the contrary, that's all I have to go on.

 

[aphistis]

Aphistis jumping to conclusions again.....Actually in my health education background (another health care professional program) I have been taught how to do a "physical" exam. So before you make a comment you might want to "ask" me! LOL 👍😀

And I am sure as a "Dentist" you were taught to do a bunch of full body physical exams in Dental School. (rolling my eyes)

Now maybe as a resident in OMFS you definitely would have to "really" know but not as a dental student or general dentist.

First, you're correct that I didn't learn to do physical exams in dental school. As an anesthesia resident, however, I do a half dozen or so every day.

Much more pertinent, however, is the fact that whether *I* was taught physical exam in dental school is completely irrelevant, because *you're* the one criticizing someone else's clinical skills in an area where you have no expertise whatsoever.

I'd love to see an optometry dropout-turned-whatever come in here and criticize your exam technique based on their "health education background" in optometry. You'd go apoplectic.

 

[IndianaOD]

First, you're correct that I didn't learn to do physical exams in dental school. As an anesthesia resident, however, I do a half dozen or so every day.

Much more pertinent, however, is the fact that whether *I* was taught physical exam in dental school is completely irrelevant, because *you're* the one criticizing someone else's clinical skills in an area where you have no expertise whatsoever.

I'd love to see an optometry dropout-turned-whatever come in here and criticize your exam technique based on their "health education background" in optometry. You'd go apoplectic.

Dude, do you post more on the OD forums than the DDS or MD resident forums. Shoudn't you be more concerned with CRNAs? I do give you props though going from one wealthy profession to perhaps one of the highest possible!