Vision Therapy a good sub specialty ?

[Opii]

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Vt?

 

[ucbsowarrior]

What are your opinions about Vision Therapy?
Does it really work? Is it a good sub specialty to go into?
Anybody done a rotation on that subject matter?
Any negative stories on the subject?
Starting to think about 4th year rotations and wondering if its worth it.

VT is an okay subspeciality, but shouldn't be your main / initial focus.
VT is over prescribed by many who specialize in this area. This actually hurts the subspeciality.
Many who specialize in VT are good, but I've met an equal number of nuts in this field who go into pseudologic methodologies.

 

[xmattODx]

VT is an okay subspeciality, but shouldn't be your main / initial focus.
VT is over prescribed by many who specialize in this area. This actually hurts the subspeciality.
Many who specialize in VT are good, but I've met an equal number of nuts in this field who go into pseudologic methodologies.

VT is a great subspecialty and CAN be your main focus but would require a lot of very hard work to build a successful practice.

Everything from diagnosing glaucoma to VT can be over prescribed. VT, however, can benefit everyone in some way.

Behavioural optometry is not "nuts". Do some research. Observes some practices and then come back and tell us what is nuts about it. It may be difficult to buy into some of what they do but they know more physiology than you and everything they do is grounded in some physiological/neurological hypothesis. Some of it seems kooky and I wouldn't do it but...?

To the OP: if you're trying to determine your fourth year rotations why not expose yourself to all that optometry has to offer? Do a VT rotation, a medical rotation, and a primary care/low vision rotation that way you can determine what you like.

 

[Opii]

Thanks for your thoughts.

 

[Richard_Hom]

(...)

To the OP: if you're trying to determine your fourth year rotations why not expose yourself to all that optometry has to offer? Do a VT rotation, a medical rotation, and a primary care/low vision rotation that way you can determine what you like.

BV/VT/DV is a bona fide specialty. In my opinion, it would be much easier if you got your exposure in your clinical rotations. In most circumstances. There are enough chances to learn about the medical aspects of optometry but few in BV/VT/DV.

Richard

 

[ucbsowarrior]

VT is a great subspecialty and CAN be your main focus but would require a lot of very hard work to build a successful practice.

Everything from diagnosing glaucoma to VT can be over prescribed. VT, however, can benefit everyone in some way.

Behavioural optometry is not "nuts". Do some research. Observes some practices and then come back and tell us what is nuts about it. It may be difficult to buy into some of what they do but they know more physiology than you and everything they do is grounded in some physiological/neurological hypothesis. Some of it seems kooky and I wouldn't do it but...?

To the OP: if you're trying to determine your fourth year rotations why not expose yourself to all that optometry has to offer? Do a VT rotation, a medical rotation, and a primary care/low vision rotation that way you can determine what you like.

Look homes,
I've been there done that. Worked with the best and worked with the so called leaders in the bv field...and what did i observe. They were under investigation by the state board.
It's widely known that bv is over perscribe for economic gains. Glaucoma can be over prescribed, but it's not for economic gain, but more for concern of the pts. condition. You need to look at the root of the actions....not just the mere similarities.
I knew a fool who used to charge people $60 to look at a blue light for 1/2 hour. Now I don't know what type of special physiology he knew, that i didn't. I just thinks he knows more about economics than physiology. it's called ripping people off.
there was this other cat who charge over $70,000 in VT to a rich family for doing vt on their kid....com'on this is a joke.
VT is a good subspeciality, but there are quite a few shady ppl in this area who wreck it for the others and it certainly is over prescribed....just do your research and look at some journals regarding this matter...instead of providing uninformed opinions and advice.

i've even seen this one nut who did accommodative training on an aphakic patient.....ya i know...he understood some $pecial phy$iology that i didn't

 

[ucbsowarrior]

Thanks, sounds like a logical approch.

ya, don't lisiten to me. you should follow the advice of some of your peers. just pls repost after your rotation and when you finally graduate and work. i just want to see if im correct.

 

[xmattODx]

VT is a good subspeciality, but there are quite a few shady ppl in this area who wreck it for the others and it certainly is over prescribed....just do your research and look at some journals regarding this matter...instead of providing uninformed opinions and advice.

Not uninformed. I'm sorry you saw "shady" people. Don't throw the baby out with the bath water. There is a thread on another forum which talks about docs doing very expensive glaucoma work ups on 0.3 cups with no nerve damage. So, like I said people over diagnose all conditions and its often for financial gain. VT/BV is something all students should look into to see if they can buy into the philosophy - and its not all about money. The OP really should do a rotation in VT. Everyone should. That way they are exposed to it and what it can and can't do. If they find out they hate it, good they won't try to do it in practice. If they find out they like it - great.

Thanks for your comments.

 

[r_salis]

Having a VT specialty is a good way to differentiate yourself from other ODs and make your practice unique. If you're interested in working with kids, I don't think it's a bad specialty to go into.

 

[Opii]

I guess I should specify more what my thoughts were on the subject matter. I am interested in Amblyopia, therapy for deviations, etc... I am just concerned with the places where they have the kids jumping on trampolines for 1/2 the time of their expensive sessions. I'm not sure I see the value in telling the kid to jump on a trampoline. In that case why don't we tell their parents to sign them up for little leauge or ballet lessons, etc. This is the part I'm confused about.

 

[ucbsowarrior]

Not uninformed. I'm sorry you saw "shady" people. Don't throw the baby out with the bath water. There is a thread on another forum which talks about docs doing very expensive glaucoma work ups on 0.3 cups with no nerve damage. So, like I said people over diagnose all conditions and its often for financial gain. VT/BV is something all students should look into to see if they can buy into the philosophy - and its not all about money. The OP really should do a rotation in VT. Everyone should. That way they are exposed to it and what it can and can't do. If they find out they hate it, good they won't try to do it in practice. If they find out they like it - great.

Thanks for your comments.

Well homes,

Let's not forget that BV can be very rewarding when done properly and when you do make a difference in someone's life. I've made differences in the lives of numerous kids, and it gives you that special feeling that money cannot buy...but like i said earlier, many of the so called bv specialist are full of quackery...to the extent that some famous profs made it a point to shut down these low lives or write articles outlining the non-sense that they engage in...if done correct...it's okay.

let me just end by saying that one of the top 5 bv rotation sites in the nation, was under investigation in the past for unethical treatment.

the whole point is that as a student you don't have the skill set to judge what is good and what is bad...only hind sight can afford you that.

all the best!...but you'll learn real fast!

I'd rather learn the stuff from a good bv prof who knows his stuff, not some nutter that just claims he's a bv expert....even if he's on the lecture circuit....i'm not bashing anyone, i'm just keeping it real!

http://www.quackwatch.org/01QuackeryRelatedTopics/eyequack.html

the question is who's going to help you guage if the clinic is quack or not?

luck is all you have to help you.

 

[xmattODx]

I am interested in Amblyopia, therapy for deviations, etc... I am just concerned with the places where they have the kids jumping on trampolines for 1/2 the time of their expensive sessions. I'm not sure I see the value in telling the kid to jump on a trampoline.

If you're interested in Amblyopia and therapy for "deviations" than a trampoline is for you! Let's say, for example, you're working with a small angle esotrope with amblyopia. First thing to do is improve VA in the amblyopic eye right? No trampoline needed. Next is to get biocularity - not binocular vision but the ability to use both eyes at the same time in a non fused state. Let's say you've been working with R/G Hart Charts and the patient can do well on near/far rocks in a stationary position. You, of course, want to challenge the patients visual system. You thus put them on a trampoline! As they bounce on the trampoline they must maintain bi-ocularity (no supression) while doing near/far rocks. Very difficult for the patient but fun and a great tool in therapy! No quackery there!

 

[Opii]

If you're interested in Amblyopia and therapy for "deviations" than a trampoline is for you! Let's say, for example, you're working with a small angle esotrope with amblyopia. First thing to do is improve VA in the amblyopic eye right? No trampoline needed. Next is to get biocularity - not binocular vision but the ability to use both eyes at the same time in a non fused state. Let's say you've been working with R/G Hart Charts and the patient can do well on near/far rocks in a stationary position. You, of course, want to challenge the patients visual system. You thus put them on a trampoline! As they bounce on the trampoline they must maintain bi-ocularity (no supression) while doing near/far rocks. Very difficult for the patient but fun and a great tool in therapy! No quackery there!

OK. That makes sense. Stressing the system while they're doing their VT to see if they can still maintain it. 😛 got it.
Anyway I think I'll ask for a rotation on this subject.
And I'll be looking out for quacks too; no Bates techniques here.

 

[r_salis]

From the "quackery" article:

There is a proven segment of vision therapy known as orthoptics which can help with symptoms of visual strain or fatigue in individuals with mild eye coordination or focus problems, double vision, or even strabismus ("crossed" or turned eyes) and amblyopia ("lazy eye") [5-6]. Many optometrists, ophthalmologists, and Certified Orthoptists offer orthoptic diagnostic and treatment services.

 

[prod]

OK, I've been following this thread for a while and I just cannot stay away from it. Some time ago I completed a residency in Vision Therapy at SUNY, arguably one of the best VT residencies and the first optometric residency to be formally offered.

Now, obviously either you had poor teaching at School or most of you only want to be Junior Ophthalmologists. Optometry's beginings come from refraction and then it progressed to the diagnosis and management of BV anomalies. Now, the present optometric trend is in ocular disease management. Not a bad progression, but you need to realize where optometry comes from.

I agree that some of the theories in VT are really out there. But... does Restasis really work, or was it approved by the FDA to increase Allergan's stock ratings at a time when it was predicted they would crash. Is Alphagan's "neuro-protective" qualities really demonstrable?? Some reasearch supports this, but others question it.

VT, as any other specialty of optometry, can be very rewarding. I don't do the fringe VT. I am more functional. I want the patients to be done with VT as quickly as possible... But that's just me. Some OD's do more basic skills: as trampoulines and even ipsilateral and then contralateral crawling. If you don't know the relationships between gross motor - fine motor and visual development then you probably did not get it, or you just did not want to listen. I am sure that wherever you go to school, your developmental/BV/VT/LD teacher must have taught you this most important sequence.

I really doubt an OD charges 70,000 for a BV evaluation. Let's see the evidence. Hear-say has no place in a forum which is supposed to be carried out by students who are on the verge of becoming Doctors of Optometry.

Vision therapy comprehends a lot of different subjects: neuro, diseases, ocular motilities, peds, etc.. You need to know a lot to really understand and obtain good results for your patients. Actually you need to know much more for VT than for therapeutic optometry.

Is VT rewarding???? Definitely. But... you must really like it and be strong enough to be at the receiving end of most of your junior ophthalmologist colleagues.

My suggestion is really pay attention to your developmental/bv/vt/learning disabilities classes. Be aware of what your are doing and putting into practice in your Peds/VT/BV/LD clinic rotations, and if you can, do a Peds/VT external rotation.

There are optometric quacks all over the place: in VT, in therapeutic optometry, in medical optometry, contact lenses, you name it. Not only in VT. Dang, there are quacks all over the medical profession.

It is YOU who makes the difference and the future OD that has to elevate optometry wherever you are going to establish your practice to new professional levels.

Good luck with your studies.

 

[ucbsowarrior]

OK, I've been following this thread for a while and I just cannot stay away from it. Some time ago I completed a residency in Vision Therapy at SUNY, arguably one of the best VT residencies and the first optometric residency to be formally offered.

Now, obviously either you had poor teaching at School or most of you only want to be Junior Ophthalmologists. Optometry's beginings come from refraction and then it progressed to the diagnosis and management of BV anomalies. Now, the present optometric trend is in ocular disease management. Not a bad progression, but you need to realize where optometry comes from.

I agree that some of the theories in VT are really out there. But... does Restasis really work, or was it approved by the FDA to increase Allergan's stock ratings at a time when it was predicted they would crash. Is Alphagan's "neuro-protective" qualities really demonstrable?? Some reasearch supports this, but others question it.

VT, as any other specialty of optometry, can be very rewarding. I don't do the fringe VT. I am more functional. I want the patients to be done with VT as quickly as possible... But that's just me. Some OD's do more basic skills: as trampoulines and even ipsilateral and then contralateral crawling. If you don't know the relationships between gross motor - fine motor and visual development then you probably did not get it, or you just did not want to listen. I am sure that wherever you go to school, your developmental/BV/VT/LD teacher must have taught you this most important sequence.

I really doubt an OD charges 70,000 for a BV evaluation. Let's see the evidence. Hear-say has no place in a forum which is supposed to be carried out by students who are on the verge of becoming Doctors of Optometry.

Vision therapy comprehends a lot of different subjects: neuro, diseases, ocular motilities, peds, etc.. You need to know a lot to really understand and obtain good results for your patients. Actually you need to know much more for VT than for therapeutic optometry.

Is VT rewarding???? Definitely. But... you must really like it and be strong enough to be at the receiving end of most of your junior ophthalmologist colleagues.

My suggestion is really pay attention to your developmental/bv/vt/learning disabilities classes. Be aware of what your are doing and putting into practice in your Peds/VT/BV/LD clinic rotations, and if you can, do a Peds/VT external rotation.

There are optometric quacks all over the place: in VT, in therapeutic optometry, in medical optometry, contact lenses, you name it. Not only in VT. Dang, there are quacks all over the medical profession.

It is YOU who makes the difference and the future OD that has to elevate optometry wherever you are going to establish your practice to new professional levels.

Good luck with your studies.

I couldn't agree more with most of your comments. I feel that suny is probably one of the top schools for bv. at ucbso there were plenty of people who were smart, but i felt that bv was one of the most misunderstood areas in 'my' program....sad but true...and i'm not sure if this can be extrapolated to some of the other schools. my bv rotations were full of quackery and some of the students from the other schools didn't even question the validity of what was going on at the practice. is it fair to extrapolate this practice to all bv practices or the field of bv itself? probably not....so i talked with ppl who were involved with investigating bv cases and practices...this person was extremely well versed in bv and practices bv in a very logistical manner. (he was a former engineer prior to becoming an od). he informed me that many practices that specialize mainly on bv are full of nutters. not all of them, but there's plenty out there. you as a bv resident and od can assess who the nutters are, but how can a od student who's just finished third year? i guess it depends if they get lucky or not.

oh by the way, i know it's hard to believe but a young male was treat over many years for over 70k in therapy at this one practice. sad, but true reality. i reviewed the file. homeboy who was running this practice was investigated by the state board.

bv should be utilized in any practice, but in a logistical manner. with methods that have been proven to be effective thru studies, not untested hypothesis or untested methods. we as od's want to practice bv, not voodoo.

 

[r_salis]

OK, I've been following this thread for a while and I just cannot stay away from it. Some time ago I completed a residency in Vision Therapy at SUNY, arguably one of the best VT residencies and the first optometric residency to be formally offered.

Thanks for joining in to share your experience and opinions. Excellent post. 🙂

 

[Opii]

we as od's want to practice bv, not voodoo.[/QUOTE]


Yes, this is my main concern. What's real and what's not.
I am just a lowly junior ophthalmologist to be so I don't know my
left from my right yet. I hope I make the right decision. 😳

 

[eyedoc23]

To OP and warrior,
As an instructor that teaches Vision therapy at one of the optometry schools, it disappoints me that "warrior" has had a bad experience in a field that I cherish.

I hope that as a doctor that wants to provide the best care for your patients that you will not rule out these treatments for those that really need them. I am not saying that someone with a CI should be performing perceptual therapy but please don't dismiss their concerns and problems as quakery.

OP, please try to consider your external rotations as an opportunity to see many different aspects of practice. Many "BV" practices also have a full primary care scope. Try to be open minded.


Marc Taub OD, FAAO

 

[Opii]

To OP and warrior,
As an instructor that teaches Vision therapy at one of the optometry schools, it disappoints me that "warrior" has had a bad experience in a field that I cherish.

I hope that as a doctor that wants to provide the best care for your patients that you will not rule out these treatments for those that really need them. I am not saying that someone with a CI should be performing perceptual therapy but please don't dismiss their concerns and problems as quakery.

OP, please try to consider your external rotations as an opportunity to see many different aspects of practice. Many "BV" practices also have a full primary care scope. Try to be open minded.


Marc Taub OD, FAAO

Before judging my lack of open mindedness you might want to see who the person defending the "BV" possibilities is on the following threads...

"Refraction" - by DOsouthpaw
"Your thoughts on my eye exam results" - by Pharmaz88

 

[eyedoc23]

Please do not consider what I wrote an attack on the status of your open-mindedness. I was attempting to balance what was being said on this thread.

My message was to keep an open mind about not only BV/VT, but all aspects of this wonderful field. If you want to speacialize in disease, do so. If you want to learn more about contacts or low vision, go for it. You have unlimited possibilities to do so.


Dr. Taub