an honest discourse…

It is not uncommon for patients and parents alike to ask why they have never heard of Vision Therapy prior to visiting a Behavioral Optometrist.  After all, other available therapy options like Physical Therapy and Occupational Therapy seem to be more widely recognized in American households, regardless of a family’s participation in those programs.  While this question offers those of us “in the business” the opportunity to rant about Ophthalmologists and Pharmaceutical companies working to suppress the true benefits of Vision Therapy, it also represents a thorn in side of Behavioral Optometry. A thorn that needs to be addressed, for the longevity of a profession.

I’d like to examine this very question:  Why DON’T more people know about VT?

Could it really be that the naysayers are correct about VT being ineffective?

Say what you will about Ophthalmologists, their model is their model, and it is successful.  At times, it seems we would have better success stopping the next tsunami with a few sandbags than ever successfully influencing their collective opinions on Vision Therapy. Ophthalmology is commonly referred to as a profession not having the same education, training, or scope of examination as Behavioral Optometry – which would seem to rank their understanding of Visual Perception right above Podiatrists and Veterinarians – and yet we still seem surprised when Ophthalmology discounts our craft.  The truth is Vision Therapy has delivered in the past, is delivering now, and will keep delivering in the future – a fact we all can all chant about loudly and proudly.  We may not always understand the neurological mechanism being triggered or the rate of synaptic firing occurring, but we are smart enough to recognize the difference between the real deal and hocus pocus. The benefits are real, the testimonials are true, and the studies are accurate. Vision Therapy works.

Could it be a marketing issue?

The efforts made to spread the word by those already in the know have been incredible. To name a few, COVDOEPNORA and PAVE have contributed incredible amounts through their websites, blogs and educational materials. There is the VisionHelp Blog which is contributed to by a group of excellent practioners who have dedicated themselves to educating the public on the benefits of Behavioral Optometry and Vision Therapy. There are many independently created and maintained websites and publications that offer fantastic information on Vision Therapy. Thanks to these folks, and so many more, information is available to those who are looking or whom want to listen. The word is out there.

Could it be a deliberate act of suppression on the part of pharmaceutical companies?

Not directly.  I haven’t read any ads or watched any commercials expressing a “VT is bogus” opinion. With the rise of the “one stop shop – medication is the answer” mentality of today, clearly pharmaceutical companies have expanded their niche and lined their pockets.  It’s hard to fathom them spending a dime on anything beyond demonstrating the benefits of their latest and greatest.  They may be luring people into believing that medication is the only answer, thereby dismissing from consideration, any therapeutic intervention.

Could it be the education of the Vision Therapists?

Bingo.  A side by side comparison of Vision Therapists and Occupational Therapists exposes one tremendous inequality – education. OT’s complete a four year degree in an applicable science, followed by a two year Masters program, and most OT programs include a specialty like hands, feet, or gait. In stark contrast, Vision Therapists come from various backgrounds which include college or not, complete on the job training, and hope to achieve certification.  Not to be misconstrued, COVT is a wonderful accomplishment, but it pales in comparison to a Masters Degree. Some therapists understand strabismus, and some don’t.  Some understand the relationship between vergence and accommodation, and some don’t.  Some understand visual logic, and some don’t.  The lack of a formal degreed education plan for Vision Therapists is a gaping hole in our profession that will continue to be exploited and give credence to those whose arsenal includes writing Vision Therapy off as a bunch of smoke and mirrors.

My conclusion: Behavioral Optometry can only be as strong as its weakest link. Make Vision Therapy a real option for Masters Candidates, and make it a career choice.  Internally our profession is incredibly concerned about Vision Therapists traveling out on their own outside the supervision of a doctor, and with the current level of education available, rightfully so.  With all due respect to all those currently lecturing and holding seminars, the current level of training available to therapists is a professional vulnerability in Behavioral Optometry that needs to be addressed if Vision Therapy is ever going to be considered a top tier modality.  There is nothing wrong with therapists understanding the findings in a 21 point exam, anomalous correspondence, or structure and function of the eyeball.  How could our profession be worse if these were a universal requirement?

The idea of doctors needing to be in the VT room and over seeing all therapy is an antiquated practice model that is limiting our growth and holding us back.  You wouldn’t expect to see your pediatrician at an OT visit, or your Orthopedist at a Physical Therapy visit.  Occupational Therapists run their own clinics, and see patients under the orders of doctors – a model that would work well provided Vision Therapy becomes a degreed occupation. Vision Therapists could operate their own clinics and be responsible for their own liability, while still receiving the treatment orders from an Optometrist and sending the patient back for progress checks. With a VT degree, Vision Therapy would become a well known profession starting at the college level of the population, slowly permeating into every household and thereby strengthening the profession.

To that end, it is my humble opinion that the pros of making Vision Therapy a free standing profession far outweigh the cons. Create a degree program for Vision Therapists equal to an Occupational Therapist’s Masters program.  As a profession, we have access to many Colleges of Optometry and we can make this happen.  If we unify in this thinking, we become stronger and better as a profession.  Creating a “VT degree” will remove any vulnerabilities currently exposed and will help John Q. Citizen truly understand the link between vision, learning and life – with or without the support of Ophthalmology.

My friends, this is the answer to the question, and it is the best way to guarantee the longevity of this wonderful craft.  Together, we can accomplish this.


Posted on April 3, 2013, in From My Perspective.... Bookmark the permalink. 12 Comments.

  1. Interesting and thoughtful suggestion, Robert. I’m curious what the perception is about this amongst other therapists, and if you have discussed this within any organizational framework such as OEPF, NORA. or COVD. If there were a degree program posted, is there a demand to justify it’s supply? Have you broached this subject with any of the Colleges of Optometry?


    • Robert Nurisio COVT

      Thank you, Dr. Press. I cannot speak for every therapist, but generally it seems one would be hard pressed to find any serious Vision Therapist who wouldn’t jump at this opportunity. Every therapist I’ve come in contact with admits their thirst for knowledge and hopes that “one day” a formal program will be available. (Case in point – Linda’s response below) In the past few years, I’ve heard of a college or two “kicking the tires” on this idea, but due to a lack of support, have not gone further with it. I am not familiar enough with supply and demand of college financials to provide a definitive answer for you, but there seems to be value in its exploration. My hope is that this blog entry will garner the support needed to open a long overdue dialogue. Thanks again 🙂


  2. Hi Robert,
    This has been a dream of mine since….forever.

    It is always awkward to me when someone asks “how can I become a vision therapist?” and I don’t really have a good answer.

    Many years ago I was involved in an OEPF project where we developed a proposed “core curriculum” for training Vision Therapists, and both VT-101 and VT-201 were developed by me for COVD with the idea of “things you would have learned in Vision Therapist school if there was such a thing.”

    My opinion:
    The philosophy and model of a particular OD is something appropriately learned “on the job,” so to speak. Things like anatomy, neurology, optics, etc. are fundamentals that can and should be taught in an academic setting.


    • Robert Nurisio COVT

      Thank you, Linda. To your point, new OD’s, OT’s, PT’s, and others are taught core skills in school. They learn philosophy and methods of practice from the doctors they choose to work with after graduation. My feeling is VT should have a long range goal of duplicating their model.


  3. Hi Robert,

    You have expressed my concern and soap box for many years. Western School of Optometry is graduating their first Optometry class in May. They are taught from day one about vision therapy. The new doctors are expecting that when they graduate that there is a pool of qualified vision therapist. Of Course, we know that is not the case.

    As co-administrator of the College of Syntonic Optometry, I often have inquires both for referrals and education of a vision therapists and how can they enroll in the “College” for a degree. This week I have one balancing weather to become an OT or vision therapist. Although, I love this profession,how can you advise one already in a degree program with a career to go into a profession with no credentials.

    Irene Wahlmeier


    • Robert Nurisio COVT

      Thank you, Irene. I am hopeful that we will someday reach a place where your concerns are a distant memory.


  4. Hi Robert,

    I cannot agree with you, Irene & Linda more!

    While organizations like COVD are great they are not a legitimate college and do not offer an accredited degree. Just like music or art therapy vision therapy should have a college program.

    Think of what that would mean for the accountability of vision therapy. Also think about what that would mean for patients and the possibility of someday actual true vision therapy coverage just like when the see an OT, SLP, NMT, etc.

    Personally I have contemplated going back to school to be an OT because like it or not many OT’s are learning more about vision therapy and incorporating it into their programs and they can bill it to insurance and it is covered. Currently I am in my final weeks of obtaining my Masters of Education so I can be apart of educating educators, going back to school for occupational therapy is something I think about often. (I would have preferred to get a Masters of Vision Therapy)

    We know that many, many drs apart of COVD will be against this and would fight this even though it would mean credibility for vision therapy.

    Tennille Moore


    • Robert Nurisio COVT

      Thank you for your thoughts, Tennille. Vision Therapy is a great profession, and it is held up by great people. My hope is that in years to come, we can make it even better. Congratulations on your Masters!


  5. I agree wholeheartedly; yet COVD is currently debating whether the COVT certification should belong to the therapist or his/her doctor.

    Over the past eight years as a vision therapist, I’ve essentially done the work for a Masters. I’ve spent hundreds of hours on my own time doing reading and research in addition to continuing education and hours of conversation with the O.D.s I work for, The upside is that this didn’t cost me many thousands of dollars in a formal educational setting. However, for my own sense of accomplishment, self-worth, and self-determination, I am currently enrolled a masters program and am planning a different career path.


  6. Interesting timing of your post; we have recently heard from two former patients, one currently in her senior year of H.S. and one in her first year of college. They were in VT during their younger years. Both are now interested in careers as Vision Therapists because of the difference it made in their lives. One asked me where I went to get my degree as a Vision Therapist as she wanted to follow that path, the other wants to come in to “intern as a therapist” so it will go towards credits she hopes will lead to something in this field. How do you tell these young hopefuls that there really isn’t a ‘career path’ in vision therapy, specifically? They were both disappointed (and surprised) to hear that there is no college degree in this field.


    • Robert Nurisio COVT

      Thank you for your comments, Ann. Since posting this entry last Thursday, I have received numerous responses detailing situations like yours. Perhaps by shining a little light on the idea, we can see clearly enough to make the changes we all seem to wish for. Hopefully your former patients found a career path that fulfills their obvious desire to impact the lives of others.


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