A Sit Down – with Dr. Jason Clopton
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. Jason Clopton
For the benefit of our readers, can you explain how you are involved in Developmental Optometry?
I have been involved in Developmental Optometry since about 2000, shortly after I graduated from SCO. My wife, Heidi Clopton, OTR/L, and I have our practices in Cookeville, TN, a city of about 28,000. We have had our individual practices since 2002. I have a B.S. in Business Management from UT Chattanooga in 1992. I worked for a couple of years before deciding to go to Optometry school at SCO. I attained my Fellowship from the IECB in 2006. I got my ABO in 2012, and now peer review is a much smaller pool.
What led you to Developmental Optometry?
When I came out of school in 1999 I had no intention of going into behavioral optometry. I thought that pathology and disease were the topics I wanted to focus on. But my wife Heidi, a pediatric OT, would come home after work and ask me why were her client’s eyes moving in such a manner? What could she do to help? What was the cause of their problems? etc
I didn’t have the answers for her. I had just graduated Optometry school. She would say, “but you are the doctor, you should know all of these things”. So, I went (as we say in the South) lookin’ fer ainsers! (looking for answers if needed some help with that). I didn’t have to look far. COVD had those answers. Then I found the book Neurology of Eye Movements written by a couple of Neuro-Ophthalmologists (Lee and Zeigh) had those answers. It was a tough book, and I could only read a paragraph or two at a time. It took many months to finish. But, in their book Drs. Lee and Zeigh lay out how the neurology points to therapy as the method of choice for correcting eye movement problems. Then I read Vestibular Rehabilitation by Herdman. This book talked about therapy for the vestibular system and the best way to monitor vestibular progress is through…vision! Reading those two books you can almost turn them page for page and they say the same thing.
Your practice is somewhat unique in that you offer both Vision Therapy and Occupational Therapy in-house. How did the decision to integrate services come about, and how do you feel it has benefited your patients?
Our practices are separate, but in the same building. Because Heidi has a practice that has OT, PT, SLP, and other services I have been able to watch, talk, and learn from them. Hopefully, they have learned a thing or two from me.
We have mutual patients and we refer back and forth pretty easily. When I see a patient that needs other services it is a trip to the front desk and not a trip across town. When they see a client that needs vision care, it is a trip to the front desk to schedule an exam. What is best is that VTODs, OTs, PTs, and SLPs all treat patients more and more similarly. We focus on different parts of the body, but when we treat the patient and not the symptoms, we get fantastic results.
Do they do what we do? Sometimes. Do we do what they do? Sometimes. Do we do it for the same reasons? Usually not. But when you are treating the person, therapeutic techniques can and will overlap. In our offices, I would say that our OTs and PTs work on more severe kids, more gross motor problems, and more fine motor problems, until they are ready for higher function work. Then they move to neuro-visual rehabilitation.
What is the Visionary Group Lecture Series?
The Visionary Group is what Curt Baxstrom and I came up with a few years ago. I first met Curt at COVD many moons ago and we started talking about how reciprocally interwoven the visual/vestibular systems are. We talked back and forth every day for a couple of years and decided that this information needed to be shared. We saw the need for presenting how the neurological pathways (subcortical to cortical processing) of vision-vestibular-proprioception-auditory-tactile systems work together and how to treat them developmentally and neurologically. Really, it is how we are treating our patients every day. Curt is really good at neuro-pathways and brain injury patients and I do pretty well with development and pediatrics and we decided to pool our knowledge. We both read and study, but Curt is the animal with gaining knowledge. He really knows his stuff. What is more important is we know that we are just on the edge of what we can do with therapy. It is opening up more and more every day. We hope that in the future, therapy is the modality of choice rather than surgery, and we have the studies to prove it!!!
Educating parents on the required duration of necessary treatment for their child seems to be a crucial aspect of managing expectations and a successful treatment plan. How do you go about helping parents understand a successful program can take time?
We take a little bit of a different approach. Because we are working on all neurologic systems and not just splinter skills, we tend to get pretty quick results. We expect to see changes in our patients in 3-5 weeks. If we don’t see progress, or progress is lost, there is a reason (seizure disorder, toxicity, methylation pathway, medicines, etc). If we can find the reason and remove it, then we get steady progress.
Our office also tracks progress on our patients (required by insurance, but that is a whole other topic). We have a 92% success rate for patients that do their homework and attend their weekly treatment sessions. Our “normal” treatment time is 20 weeks or less. If there are co-morbid factors, (CP, Developmental delays, autism, etc) the treatment time can go up from there, but we document that in the initial evaluation.
We bill per session. If the patient/parents aren’t satisfied within 3-5 weeks, there has to be a reason. It is usually that they aren’t doing their homework.
As we were setting up this interview, you agreed to answer questions directed at the continued skepticism of Vision Therapy as a positive treatment modality. For starters, do you feel strabismus surgery is a valid treatment option when done in conjunction with Vision Therapy?
If you look at outcomes of all kinds and criteria for success, there is absolutely no question that therapy is cheaper, has better outcomes, is more permanent, and does much less harm. The Cochran database shows that surgical intervention for strabismus has a much higher rate of failure, many more side effects like DVD, IOOA, consecutive strabismus, latent nystagmus, and second surgeries. All of these side effects with a cosmetic rather than functional threshold for success!!! Do no harm… I guess it is just a saying. Therapy is a “no brainer” if you look at all the facts (pardon the pun).
In a time when alternative treatments and even Marijuana for Medical Purposes (MMPR) are becoming more widely accepted, why do you feel the skepticism around VT’s effectiveness continues to exist in the first place?
Pure and simple, it is a turf battle. VTODs do therapy, OMDs don’t. OMD’s do surgery, ODs don’t. We have training in therapy, they don’t. They don’t study, or have knowledge in therapy. It is not taught in their schools. They have training in surgery.
As a doctor and a business owner, how do you manage a parent’s request for “data” verifying VT’s effectiveness?
First, I present the Cochran database on surgical outcomes, cost, and possible side effects. That is something they don’t hear from OMDs. Second, I explain the difference in outcome criteria. Our’s is a functional, usable vision goal while strabismus surgery is a cosmetic goal possibly requiring multiple anesthesia without any functional goals. Surgery takes hours to achieve poor to harmful outcomes. Therapy takes months and hard work with functional outcomes. The AOA, COVD, and NORA all have very large databases on therapy studies with hundreds of references. AOA’s Clinical Practice Guidelines state that therapy is well studied. Non vtOD’s don’t know this. We need to get the word out. Good outcomes help.
A common criticism of Developmental Optometry has been that when the topic of strabismus treatment arises, VT’s first defense is to point out that strabismus surgery doesn’t work, rather than in the affirmative about our own services. How do you respond to this criticism?
Sometimes we are our own worst enemy. We are a “get it done now” or “take a pill for your ill” society. As in the last question, therapy takes a long time with hard work. Surgery is quick and is cosmetically good.
In the past, therapy did gain desired outcomes without having the neurologic background to support what we did. We had the answers without knowing exactly the whys. I guess that is why it is called “behavioral” optometry.
Is it a muscle issue? A neurologic pathway issue? Perceptual issue? Developmental issue? Or a combination one or all of these? Different issues at different times?
Now, with fMRI studies, better understanding of neurology, how the brain processes information, vestibular knowledge, motion processing knowledge, and better studies, I just don’t see how we are still doing surgery. This will change. It just takes time.
The CITT study successfully demonstrated Vision Therapy had positive effects in treating Convergence Insufficiency. Why can’t all Vision Therapy services be proven with double-blind and placebo based studies?
First, we have to talk about studies. Some of our colleagues and OMDs talk about the lack of “gold standard” studies for vision therapy. This is pure hogwash!! There is no such thing as a “gold standard” study for: OT, PT, SLP, Surgery, or any kind of therapy. Gold standard means that you have to double blind, placebo control, and randomized treatment. A surgeon knows if they are doing surgery or not. A therapist knows if they are doing therapy or not. Show me the double blind surgery and I will show you the double blind therapy. It can’t be done, except with a pill or a computer. The only instance of any “gold standard” therapy of any kind or surgery is the CITT because it was done on a computer. That is why it was such a big deal. The therapist didn’t know if they were getting therapy and the tester didn’t know if they were getting therapy. This is the only “gold standard” study in all therapy or surgery.
One point that remains baffling in the area of strabismus treatment is the idea of Western Medicine accepting sub-optimal surgical results over a less invasive process like Vision Therapy. Do you have any thoughts on this perception?
Turf. MDs refer to MDs.
Some Developmental Optometrists share in the opinion that surgery is a valuable tool when done in conjunction with judicious applications of Vision Therapy. Do you agree?
Sorry, I don’t think that surgery is an option except for cosmesis. I haven’t sent out for a surgery in 10 years. 🙂
On a personal note, you and your wife are running a highly successful practice, while at the same time raising four beautiful children – no easy task. As a married couple, how have you found balance between your professional and personal lives?
We have been blessed in that we built my wife’s practice before having children. We have been able to hire therapists to work in her place while she raised our children. With our first child she worked a couple of days a week, part time. With our second child she was at the office with the kids 1 or 2 days a week for only a couple of hours, but the kids had lots of developmental stimulation. By our 3rd Heidi was able to stay at home and I ran the business. We are truly blessed to have this advantage. Now that all of our children are in school Heidi is able to work more and we are seeing growth even with a down economy and being in a small town.
Some Closing Thoughts – A great thanks to Dr. Jason Clopton for taking the time out of his busy schedule to do this interview. Clearly, he is very passionate about helping people and his willingness to address these tough topics for this interview is very much appreciated. He truly is a class act. Please join me in wishing Dr. Clopton and his beautiful family, the absolute best! 🙂