A Sit Down – with Dr. Rob Fox
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. Rob Fox
For the benefit of our readers, can you give us some information on your background, and explain how you are involved in Developmental Optometry?
My background is a bit unusual in that I originally studied engineering before I decided to change course and go into optometry. As a result, I had different challenges in optometry school. I found optics very easy, but it took me longer to get the hang of anatomy since engineers are not required to memorize things. I actually found that engineering meshed well with developmental optometry as both take a “systems” approach to vision, treating the whole individual, not just a pair of eyeballs. Engineers are also problem solvers which is something we as developmental optometrists do in our practices every day.
My optometry schooling took place at the SUNY College of Optometry in New York City. After graduating I spent a year as a resident at the Northport VA Hospital in New York where I developed my interest in the treatment of patients with brain injuries and strokes.
My practice and its involvement with developmental optometry has changed greatly over the years. In the beginning vision therapy was a small part within my full scope practice. Over the past 10 to 15 years we have changed gears and are now a practice that is a VT only practice. I am also on staff at a local rehabilitation hospital.
What led you to Developmental Optometry?
I actually need to give the credit here to my late mother-in-law for this. When I was dating my future wife, Randy, her mother sensed that I was not happy with engineering. She was a special education teacher and introduced me to Dr. Marty Birnbaum, a giant in Developmental Optometry (though I did not know that at the time). Dr. Birnbaum was a wonderful mentor and convinced me of the impact Developmental Optometry can have on the lives of children.
Along with Developmental Optometry and Vision Therapy, you have also incorporated Syntonics into your practice. For those who may be unfamiliar, can you explain Syntonics and how it works?
“Syntony” means “in balance.” In syntonics we use the application through the eyes of specific combinations of light frequencies (color combinations) to restore balance to the autonomic nervous system. For example, a patient with eyes that over-converge has too much parasympathetic tone in there visual system. The treatment in syntonics would use a sympathetic stimulant to restore balance, in this case you would include a red filter in your treatment.
Is there a population of children that Syntonics is more effective?
I find syntonics to be a useful tool in a wide variety of cases. I have seen great improvements in children on the autism spectrum and have also found it to be very helpful in strabismus.
With March being Brain Injury Awareness Month, can you explain how Syntonics is beneficial in the treatment of patients with Traumatic Brain Injuries?
The TBI population can benefit greatly from developmental optometry and, more specifically, from syntonics. The symptoms of post-traumatic vision syndrome include exophoria, exotropia, poor accommodation, and constricted visual fields. These are all signs of a sympathetic system in overdrive. In these cases we select a syntonics filter combination to enhance parasympathetic function. These same colors have a palliative effect and help to promote fluid reabsorption in the neural system.
I would like to add that the area of brain injury rehabilitation has given developmental optometry a tremendous opportunity to really show the public and the medical field what we are capable of. More and more rehabilitation centers are utilizing optometrists and more optometrists are taking the leap and beginning to treat these patients with excellent results.
A great deal of attention has been given recently to Traumatic Brain Injuries, and specifically concussions suffered in sports. Can you explain how concussions work, and why frequent or multiple concussions can have long term damaging effects?
To really get into an explanation of how concussions work would probably be beyond the scope of this interview. Suffice it to say that the Concussion in Sports Group defines it as – “a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces.” Basically it is trauma to the brain that may, or may not, involve loss of consciousness. Problems encountered may be cognitive, physical, or emotional. In some cases, the symptoms may resolve briefly. In others the problems may be long standing.
The problem in student athletes is that even though symptoms may be resolved, the brain may still not be fully healed from injury. If a child has a second, or third concussion while still recovering from the first, the consequences may be severe. Recent research shows that many children require up to one year to fully recover from a concussion.
How can Vision Therapy help treat patients who have suffered one, or multiple, concussions?
Concussion patients develop many of the conditions frequently seen in vision therapy practices. These include poor convergence, poor accommodation, poor eye movements, and reduced peripheral awareness. Complaints include blurred vision, double vision, headaches, poor balance, and reading problems.
Though we must adapt to the specific patient, the use of lenses, filters, prisms, selective occlusion, and optometric vision therapy can help many of these concussion patients recover. Many school age patients are unable to return to school until they have completed a course of vision therapy which enables them to read and to learn as they did prior to their injury.
You currently serve on the International Examination and Certification Board (IECB) which is responsible for certifying both Developmental Optometrists and Vision Therapists in vision development and vision therapy. For those who may be unfamiliar, can you detail how the process works?
I am so glad you asked me about this. One of the core missions of COVD has been the certification of optometrists and therapists in vision therapy and vision development. With all the recent talk about board certification within optometry people forget that COVD has been doing this for over 40 years.
The process is most straightforward. For optometrists, you must be out of school for three years and have taking a total of 100 hours of VT related continuing education. The first part are the open-book questions, designed for the candidate to share their model of vision and their basic understanding of vision and vision development. Next we ask for three cases – a lens treatment case, a learning-related case, and a strabismus case. Once these are completed the candidate will sit for a written multiple choice exam, and then an oral interview at the annual COVD meeting. For therapists the process is similar except that cases reports are not involved. All this information, and more, can be found on the COVD website.
As an IECB member, what advice would you offer doctors considering fellowship and vision therapists considering certification?
I think the key thing is for the candidate to find a mentor that will guide them through the process. The certification process is meant to be a growth process for the candidate. Having a mentor to review materials and to discuss cases and questions with is most important. The mentor can also help you prep for the oral interview and reduce the stress levels candidates have for that section. My other advice is to just do it! – you’ll be glad you did.
Along with other speaking engagements, you recently completed a lecture for the OEPF Great Lakes Congress. Do you enjoy teaching and sharing your knowledge with others?
When I was a young student I was terrified to speak in front of groups. Now I have found that speaking has given me an opportunity to continue to grow as a developmental optometrist. Preparing to lecture really makes you analyze your approach and put it into terms so that others can learn from you. It is tremendously rewarding when attendees come up and thank you for getting them to try new things at their own offices. Our educational groups, such as OEP, should be commended for providing chances for many ODs, with different perspectives, to share their knowledge with others.
Some professions outside of Developmental Optometry are now taking a proactive approach in downplaying Vision Therapy’s value. As a doctor, how do you manage this idea?
Unfortunately, this is nothing new. I have been dealing with this my entire professional career. Most of those that downplay VT do so out of ignorance and lack of understanding of what we really do. I think the key thing is to “think globally, but act locally.” First of all, providing VT with excellent results will result in the word spreading in your community about your services. We have also taken it upon ourselves to provide frequent workshops, in our office and outside, too, to educate the public. We also try to get written reports of our findings in front of as many of those working with a child as we can.
Do you feel there will be a time in the near or distant future where Western Medicine will consider Vision Therapy the first line of defense for those children struggling in school or even those with attentional challenges?
I wish I had a crystal ball to answer this one. The main positive change I have seen is the growth of the internet as a source for information to parents. In the past the child’s pediatrician was the only source for the parents of struggling school children to get information. This usually did not result in a visit to the optometrist. Times have changed and parents are now empowered to do research on their own. New groups such as “Vision Therapy Parents Unite” on Facebook are helping more and more parents discover what developmental optometry can do for their children.
Since you’re a “New Yorker”, I have to ask: Mets or Yankees?
I am a die-hard Mets fan. Brings a whole new meaning to “rooting for the underdog.”
Some Closing Thoughts – A great thanks to Dr. Rob Fox for this interview. His willingness to share his vast knowledge and range of experiences is very much appreciated – plus he’s a New Yorker who doesn’t like the Yankees, which makes me like him all the more!! Please join me in wishing Dr. Fox and his family the absolute best 🙂