A Sit Down – with Dr. Glen “Bubba” Steele
This post appears as part of a series called Sit Down – candid conversations with real people detailing their journeys and experiences with Vision Therapy.
A Sit Down – with Dr. Glen “Bubba” Steele
For the benefit of our readers can you explain how you are involved in Developmental Optometry?
I am involved in the developmental aspects of optometry in a number of ways. I am a professor of pediatric optometry at the Southern College of Optometry in Memphis, TN where I have worked for 44 years. I had a private practice for 40 years in Memphis having retired in 2012. As a member of the APHA Vision Care Section, I serve as Awards Committee Chair. I do Regional Clinical Seminars for the OEP Foundation and am significantly involved in the InfantSEE program of the AOA Foundation, currently serving as Chair. I am a member of the SECO Continuing Education Committee and I do a bit of CE in addition to the OEPF RCSs. Everything I do is focused on the vision contributions in the process of overall development.
What led you to Developmental Optometry?
Upon graduation in 1969, I immediately went to work at SCO. One day, the head of the VT service asked me if I wanted to go to the Gesell Institute for a year. I had no idea where Gesell was and so really had to think about moving away for a year. When I said yes and did that, it was one of the most incredible life-changing years of my life and shaped my career in a very positive way. I went there from 1970-71 along with Al Fors who was a fellow student and faculty member at SCO for 47 years. Al is an incredible mind and there are few better colleagues in our profession. I am proud that an endowed scholarship has been established jointly in our name at SCO.
There are no words to describe the opportunity Al and I had to work with John Streff and Dick Apell for a year. We interacted with some of the best minds in optometry and allied fields through the Gesell experience that I treasure today. Also having the ability to work with Dr. Frances Ilg, Dr. Louise Bates Ames, Jacqueline Haines and Dr. Richard Walker laid a great foundation for me in the whole area of child development. This group fortunately saw the critical importance of having vision recognized as a major piece in the process of overall development. There was such an importance placed on the development of vision that other aspects of care were often postponed until vision issues were identified and remediated. Gesell himself talked about vision issues long before he wrote the book Vision: It’s Development in Infant and Child so there is little wonder that his concepts were carried on long after his death. It is my life goal to ensure that the concepts learned so long ago by so many before me are carried on.
How did you become a professor at Southern College of Optometry?
When I returned from Gesell (which was a part of the SCO requirement), I was involved in the clinic and the VT lab along with Al Fors. I served as Chief of the Pediatric Service prior to retiring from that position just over five years ago. I continue to work full-time at SCO and am so very thankful for the privilege of working with so many talented people over my career.
In addition to my work at SCO, I had a private practice for 40 of those 45 years and believe that is necessary component for any clinical practitioner. Owning a practice made my clinical decisions more direct for the patient and having personal responsibility for the patient always makes one a better practitioner. My practice was 60% vision therapy and my time at SCO and the Gesell Institute laid the foundation for both practice and teaching at the college. To see young patients move from daily struggles to having the ability to complete their work in a reasonable time continues to be rewarding and it is all based on a developmental model acquired during my years at SCO and enhanced at the Gesell institute that were heavily based on the foundations in developmental optometry. SCO even had a course in developmental optometry during my days as a student.
I see many other organizations involved in development but they do not often realize that vision is a major component in the assessments they make. These include social and emotional milestones and cognitive milestones. I see this as major opportunities for optometry. Working very closely with young children in both practice and the college clinic has provided an exceptional background to engage with the leaders of those organizations as we talk about changing lives of patients. I am in strong support of OEP’s new program – Optometrists Change Lives.
Educating parents on the duration of treatment necessary for a successful Vision Therapy program seems to be crucial aspect of patient care. In extreme cases, Vision Therapy can take in excess of a year to reach a successful outcome and there is always the risk of parental frustration which may result in early withdrawal from a program. How do you go about helping parents understand a successful program can take time?
In the beginning, I determined the need for therapy based strictly on the tests in my examination. It was often difficult to communicate the links between our findings and the child’s problem. It was at the suggestion of my therapist (who also happened to be my wife) that we put together a grouping of tests that would serve to help parents understand the issues initially and also to more effectively communicate improvements as therapy progressed. This additional testing has very effective in communicating the problems and solutions with the parent for over 30 years.
I began spending a good deal of time on the front end with parent consults to ensure they understand the link between the problems they see with the child and the results of tests that we did. When they begin nodding their head in the affirmative, I knew we had a connection. It must happen in the beginning or the doctor and therapists will always be playing catch up. I also find that some of the more difficult cases to explain are not the complicated cases but those that appear to be simple on the initial testing but turn out to be complex when more in-depth testing is done.
You have been a strong champion of the InfantSEE program which provides free vision and eye health screenings for children less than one year of age. How did you become involved with InfantSEE, and why is it such an important program?
InfantSEE is a wonderful concept and I have been privileged to be a part of it. In 1998, Dr. David Sullins, an AOA past president, came out of a meeting about vision and learning and I happened to be standing right outside the door. He said, “Bubba, school age is too late. What if we started seeing them as infants?” That began an idea that was first promoted in TN and then adopted by the AOA in 2003 and became InfantSEE. We launched in June of 2005 and unfortunately, David passed away in February before the June launch.
We now have over 7,000 ODs as who have volunteered to participate in InfantSEE. This is a program where these volunteers provide a comprehensive assessment for babies between 6-12 months of age without charge to parent or insurance company. These assessments are much more than screenings and add to the well-baby checks done in the pediatricians offices which are screenings. Our goal is to have InfantSEE recognized as the portal of entry into the vision health system.
As of August 2013, we have had data on over 100,000 babies reported to us by the volunteer doctors. The data is masked so it does not leave the doctor’s office with the baby’s name or any personal information. While this makes it difficult to follow over time, it does meet HIPAA guidelines.
The traditional screenings that are done look only for strabismus ands amblyopia beginning at age three. This process consistently shows 3% of babies with visual risk factors. Through the InfantSEE data, we are seeing just over 10% of babies with risk factors in these 100,000 babies. Those with a developmental background do not find this surprising but to many, it is a huge revelation regarding the number of potential risk factors and borders on a public health epidemic. Identifying and providing intervention at earlier stages in life is always more efficient and cost-effective.
This is a program that came about at a wonderful time in my career. I have always had an interest in younger patients and involvement in InfantSEE required me to begin thinking and collaborating with organizations and people who I never knew existed. There are so many organizations working with infants and young children and developing these relationships and InfantSEE has opened doors not recognized by optometry in the past. The AOA is to be commended for their support of InfantSEE as is OEP and COVD.
Along the same lines, when strabismus is discovered in an infant or perhaps even up to the age of three, what are your treatment options? Will you ever recommend surgery?
When strabismus is discovered in a young patient, particularly an infant, too often, ODs abandon normal developmental protocols and go the high plus or surgery route. The presence of strabismus is an indication that overall development is off course. Using a developmental background, the first choice should be movement activities which includes eye movements coordinated with body movements. The first thing I do is eye stretches, not to strengthen the muscles but to achieve better looking behavior patterns. Strabismus surgery may be a later option but only after other means of achieving appropriate looking behavior have not been successful.
Cost of treatment seems to be a perpetual discussion amongst VT patients and parents. Some argue that a few thousand dollars to improve a patient’s life with vision Therapy is a drop in the bucket while others balk at the exorbitant fees. How have you managed the cost issues with your patients?
Those issues will always be present with anyone practicing vision therapy. The important thing to develop is an attitude that you as an individual practice team have something very valuable to offer. Do not let your attitude get in the way of offering services to patients who can benefit from them.
When I was early in practice, I made a connection with a literacy person in Little Rock, Arkansas. After several patients and primarily recommending “home therapy,” I had a parent ask if we provided vision therapy in the office. When I replied in the affirmative, she asked if her daughter would benefit from office therapy. Again an affirmative answer resulting in my feeble excuse that I assumed because of the distance involved that “home therapy” would be easier for them. Her response stunned me – “You let me make that decision.” Now for the past 30 years, I have recommended vision therapy as if the patient lived right across the street regardless of distance. I have had about 80% of those long distance patients accept with the drive being much more time-consuming than the actual vision therapy session itself. Do I still have patients who cannot make the short drive from six miles away because “it is too far?” Yes but you must always leave the door open should they decide to come back.
As a result of that, I no longer use the term, “home therapy.” It is home stimulation and home reinforcement but offering options of office or home therapy have not been in my vocabulary for 30 years now.
Growth of membership and Annual Meeting attendance…
One of the major things is annual meeting growth. There were 250-300 present in the middle years and now around or over 700 are in attendance with considerable student involvement. This leads to the opportunity for more growth.
Dr. Robert Wold was a founding member of COVD, served as president of the organization in 2000-2001, and as you know he passed away at the young age of 58 prior to completing his term in office. As a former board member, can you speak to the impact Dr. Wold had on the world of Developmental Optometry and specifically the growth of COVD?
Bob was the glue that held the organization together for many, many years. He kept copious minutes and a tight fist on the checkbook. COVD would not be where it is today if not for Bob Wold.
Many did not know that he was also a prankster. During the Board meeting on the Sunday following the annual meeting, I could not find the gavel to begin my first Board meeting as president. Shortly, a hotel employee brought me the gavel – totally frozen in a bucket of ice. It was late afternoon before I could stop using my pen and use the gavel.
Bob had a great desire to bring people together and COVD is but one example. COVD was formed from three organizations coming together and Bob was the glue. It is my hope and desire that all entities working together from the developmental standpoint work more closely together and coordinate efforts to open more doors for optometry and optometrists just as Bob did. He recognized we were all much more alike that different and that each of us has unique ideas and opportunities that the other organizations do not have. He worked diligently to bring things together rather than push apart very much like we do when working with parents, teachers, pediatricians, and other groups.
COVD’s Annual Meeting is coming up in October. As a former Board Member and Past President, what do you enjoy most about the meeting?
The people. I enjoy getting together with those I have not seen since last year. Many I worked with on the Board in the mid to late 80s and other friends from all over the world. COVD was my start into organized optometry and I hold these roots as extremely important.
On a personal note, you refer to yourself as “Bubba”. Where did that name come from?
In the mid-80s, I was a part of a traveling road team for the AOA along with Irwin Suchoff, Allen Cohen, and Sue Lowe. If you know nothing more about those individuals other than they are three of the most dedicated people I know, then you know the make-up of the group. We became very close and remain so today.
As it became my time to present, I occasionally made the statement that we had such a good mix of people – two New York Jews, a wild woman from the west and a redneck. Irwin started calling me Bubba to which I replied, “That’s Dr. Bubba to you!” At the conclusion of the session, I went outside and had my name badge changed to Dr. Bubba. It only took three months for the Dr. to fall off and I have been Bubba ever since, thanks to Dr. Irwin Suchoff who himself is now a Bubba living in Atlanta, GA. And the rest is history….
Some closing thoughts – A special thanks to Dr. Steele for taking time out of his very busy schedule to complete this interview. I doubt he remembers, but Dr. Steele and I first met in Ft. Lauderdale at COVD’s Annual Meeting in 2002. I was pacing the halls during lectures while holding my screaming 6 month old daughter trying helplessly to appease her and bumped into Dr. Steele as he exited the Men’s Room. He must have seen the frustration on my face, or more probably felt compelled to help as clearly is his nature and quickly produced a flashlight from his pocket. With it, Dr. Steele converted my daughter from a whimpering mess into a ball of giggles in under 30 seconds. We shared a laugh, and just like that, he disappeared back into the lecture hall. It was not until the next day that I discovered who he was. Every year since, I’ve looked forward to shaking Dr. Steele’s hand during COVD’s Annual Meeting, my little way of thanking him for his help. He is truly a class act. Please join me in wishing Dr. Glen “Bubba” Steele the absolute best!