Found the article interesting, and I was wondering what some of the Ophthalmologists who browse here think. Don't forget to look at the comments. Most of the optometrists mentioned in the article start posting.
http://www.nytimes.com/2010/03/14/magazine/14vision-t.html
Obviously this thread is likely to get contentious quickly but as an optometrist who does SOME vision threapy, I will say the following:
Vision therapy is kind of like chiropratic. 90% of it is totally legitimate, and 10% of it is pretty wacky. Unfortunately, it's often the 10% that gets all the attention. Much like there's chiros out there claiming to cure cancer and MS by spinal manipulation, there's some wacky VT guys out there claiming that they can cure your autistic kid by having them hop and down on a balance beam wearing different strength prisms.
So leaving out that wackiness, I believe that VT is an effective legitimate treatment for many things. Most optometrists have seen all kinds of kids benefit TREMENDOUSLY from VT after years of being told by educators, psychologists, pediatricians, teachers, special ed people, neuro-psych people et al that "there's nothing wrong with you." "You're just lazy."
I basically agree with Guyton on this statement:
Guyton said:
At base, the dispute comes down to the fact that behavioral optometrists and pediatric ophthalmologists define what constitutes a diagnosable level of problems like convergence insufficiency differently. The two professions cant talk to each other because their basic definitions are so different, Guyton says.
Guyton says that many of his colleagues in ophthalmology can be too categorical in condemning vision therapy, which he says can be of real value in helping patients overcome a number of eye problems. The trouble is, he says, behavioral optometrists overstate their claims, generalizing, for example, from the evidence that vision therapy works for convergence insufficiency to validate all that they do. You really cant validate by association, Guyton says.
I've seen dozens of children with convergence insufficiency told by pediatricians ophthalmologists, even other optometrists "there's nothing wrong" or "they don't have CI."
And when you do one quick near point convergence test on them, yea, it might be normal. But try repeating it a couple of times. Or do a couple of tests that require sustained convergence at 16 inches on these children and it's a catastrophe. No small wonder they have "ADHD" or can't read. If I got transient diplopia or a headache after 30 seconds of sustained convergence, I'd probably avoid reading or start bugging the kid sitting to me too.
So does VT cure ADHD? Of course NOT. Does VT cure learning disabilities? Of course NOT. Do these things sometimes get misdiagnosed? Oh yea.
I've also seen all kinds of kids diagnosed with any one of a host of learning problems/ADHD who after years of intervention at school or occupational therapy or speech/language therapy, nothing has improved. After 6 weeks of VT, the improvement is incredible. Why?
Because these are often the children who had an "eye exam" at the school nurse or the pediatrician's office that went something like this:
Cover your right eye. Can you see? Yes?
Cover your left eye. Can you see? Yes?
There's nothing wrong with you.
But it should be fairly obvious to anyone that calling out letters on a chart from 20 feet away, monocularly, has essentially zero bearing on whether you can read words on a page, 16 inches from your face, with both eyes open, and keep your eyes continuously focused on the page, and keep them continuously pointing at the same point on the page, and move them across the page making a whole series of minute saccadic movements that we're not really designed for all the while trying to get all of that into your head.
Remedy that problem, (which is incredibly easy to remediate) and suddenly they LOVE reading. Suddenly they have NO PROBLEM sitting at their desk in the 3rd or 4th grade for most of the morning. Suddenly the 1/2 hour of homework takes 1/2 hour, instead of the previous nightly 2 1/2 hours of whining, complaining, nagging, avoiding, threatening, grounding, punishing, rebelling aggravating nightmare for kids and parents alike.
So is VT utopia? No. Of course not.
Is VT highly effective for the things it's effective for, and can it have a tremendous impact on people's lives? 100% for sure.
I will also say that in my office, I do NOT charge "thousands of dollars" for VT and I do NOT keep patients in therapy for 20, 30, 40 weeks at a time. We've all seen the patients going through these incredible therapy programs that have lasted years on end with minimal or marginal improvement in academic performance.
The vast majority of the patients that I take on get substantial remediation of their problems within 12 weeks. I get a fair amount of referrals for VT evaluations and I can honestly say that I actually refer MORE of those patients out for family counseling/therapy than I agree to do actual VT on. You can almost always tell within a 15-20 minute exam and discussion with mom and/or dad (preferably both) in the room that the family dynamic is TOTALLY dysfunctional.
Most of what I prescribe for the patients I DO take on involves 15-20 minutes of home therapy a day and a 1/2 hour office visit every week for the first four weeks and then alternating weeks for the remaining 8. Most major medical plans in my area will cover 4-6 office visits. So the most out of pocket expenses that the vast majority of my patients have comes out to 4 1/2 hour office visits which usually comes out to a few hundred bucks.
So I don't get the "thousands of dollars." I can only fantasize about that. lol
So here we go......let the great debate begin. Hopefully it can remain civil on both sides.
