A Sit Down – with Dr. Jenna McDermed
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. Jenna McDermed
For the benefit of our readers, can you explain how you are involved in Developmental Optometry?
I’m a Developmental Optometrist, Fellow of COVD & practice at the Visual Health and Learning Center in Orlando, Florida.
How did you first hear of Developmental Optometry and what led you to become a Developmental Optometrist?
Before I fell in love with Developmental Optometry, I fell in love with neuroscience & visual perception. In my time as an undergraduate at Penn State, I earned my BS in physiology with and emphasis in neuroscience. This meant that I not only studied neuroanatomy & neurophysiology, but also took courses in child development, sensory perception, psychology & electrodiagnostics. I became intrigued with the process of visual perception & the things that could go wrong if this process is interfered with, such as in a brain injury. I particularly became interested in disorders such as blind-sight (where a person can become functionally blind but still perceive visual information) & visual field neglect (where a person ignores part of their visual world). I learned that seeing is done in the brain and not in the eyes. I decided that I wanted to find a profession that worked with people with these types of difficulties, and found Optometry.
I went to Optometry school at Nova Southeastern University, and had several wonderful mentors along the way who encouraged me to take courses through COVD & OEPF that weren’t offered in Optometry school. I’m particularly thankful to Dr. Richard Sorkin (FCOVD) for mentoring me during my externship & fellowship processes. By the time I graduated in 2006, I had decided that I wanted to devote all of my professional career to vision therapy & that I would open a vision therapy practice where I could help fill the needs of the children & adults in my community.
What can you tell us about The Visual Health and Learning Center?
I opened the Visual Health and Learning Center in 2007. When I started, I was the only employee; playing the roles of receptionist, doctor & vision therapist. VHLC is a vision therapy based specialty practice, serving the needs of Central Florida, and I receive referrals from Optometrists & other professionals in the area. Over the past 7 years, the office has grown to have seven vision therapists and an associate doctor, Dr. Chi Tran, who have joined my wonderful team. We even have the honor of working with patients who have flown in from around the globe to work with us, and we have met so many wonderful families as we’ve grown!
You became a Fellow of COVD in 2011. Can you tell us about that experience?
The fellowship process was a wonderful growth opportunity. It took me several years to complete, as my husband and I started a family somewhere in the middle of the process. In particular, it helped me to put together my model of vision & determine areas of learning that I would benefit from continuing to grow in. Being a Fellow of COVD also establishes you as a specialist in the areas of vision therapy and visual development among your colleagues. Neuro-developmental optometry is a rapidly growing field, as new research is coming out exponentially in the vision sciences, and all of this new research directly affects how we practice. Because of this, the learning process in this field is ongoing. Without being specialized in this area, it would be unrealistic for a professional to keep up with the advances in learning that are coming out of this specialty area.
Can you tell us about your team?
I have such an amazing team of vision therapists that I have the pleasure to work with. Each of them has different backgrounds in teaching, psychology, child development & early intervention, and in working with children with special needs. One of my vision therapists, Melody Lay, was featured in a previous sit-down interview.
We see many different types of patients in our office, including children & adults with learning related vision disorders, acquired brain injuries, strabismus & amblyopia, sports vision, and military vision. But I really feel that, as a group, we excel in working with children with special needs. I’m so proud of what my team has achieved, many times with children who were “written-off” by other doctors or professionals. Their patience & compassion humbles me daily.
Switching gears a bit, the treatment of strabismus tends to be a polarized topic between Ophthalmology and Developmental Optometry, and one that seems to perpetually be in the forefront. Some Developmental Optometrists seem to view strabismus surgery as a valuable tool when done in conjunction with Vision Therapy, and others feel differently. Where are your thoughts on the matter?
I truly feel that every patient that walks through my door has a unique story, and so I approach each case and treatment recommendation in this way. As Developmental Optometrists, we are in a unique position that we have many tools that we can access when addressing the needs of our patients. For most of us treating strabismus (eye turns or misalignments), these tools include lenses, patching, surgery, & vision therapy. Not only that, but within the vision therapy room we can take different approaches to the treatment, including vestibular & motor based therapy, ocular-motor & orthoptic based training, and sensory-based training.
With all of these tools at our disposal, why would we want to limit ourselves to just one or two treatment strategies? However, it is extremely important for parents to understand that surgery is no magic bullet. In fact, it can come with complications that can sometimes inhibit the visual learning process in the therapy room, and it’s not unusual for patients to require multiple surgeries. Even when the child’s eyes look straight after surgery, if the underlying developmental dysfunction is not addressed, the child may still have significant visual difficulties that remain, sometimes undetected. However, I believe that it has its place in cases when the patient’s or doctor’s goals aren’t met with vision therapy alone.
Many parents are told by other medical professions that denying strabismus surgery to their child will result in blindness of the affected eye as the child grows. Does that really happen?
Although it is, I feel that it is important to emphasize to parents the potential risks of strabismus, I find that this approach is closer to a scare tactic than true education.
Generally, when a parent is told this, the doctor is referring to the development of amblyopia (reduced vision of the affected eye), which can occur through active suppression of the turned eye during the developmental process. However, it is important to remember that there are many factors that can affect the development of amblyopia, including how often the eye is turned and what strategies the child is using to compensate for the eye turn. The risk of amblyopia can only be determined when a doctor looks at all of the risk factors and treatment strategies.
Amblyopia is a serious issue & it is important for parents to take steps to treat it as early as possible. However, surgery is not the only treatment option, and there is not guarantee that surgery will prevent Amblyopia from developing. The best treatment strategy for preventing the development of amblyopia is to ensure the eyes are functionally aligned. This means that, even if the child’s eyes “look straight” after surgery, if the child is not using both eyes to functionally work together, amblyopia can still develop. Only a professional trained in functional vision will be able to assess how to best accomplish this goal. This may be through a combination of treatment modalities.
Also, even if the child develops amblyopia, it is a treatable disorder. New studies in neuroscience & vision science are helping us to understand that we can even treat longstanding functional vision disorders, such as amblyopia, due to the brains neuroplasticity. Overall, when a parent is making a decision about the treatment of strabismus, they should make their decision based on understanding their treatment options and likelihood of a positive outcome, and not based on scare tactics.
For the parents who will be reading, can you explain why some children are born with an eye turn and some develop a turn later in life?
It is first important to note that most strabismus is not congenital, and most babies are not truly born with it. Infantile strabismus develops in the first few months of life, generally in the form of infantile esotropia (an inward eye turn) before six months of age. Other forms of strabismus can develop later, but generally before the age of three.
To understand this, we really need to look at the causes of why different types of strabismus develop. It is important for parents to understand that we are not born with vision, but that vision develops. Just as a child learns to walk & talk, they learn to perceive their vision and move their eyes. Since vision is developed, or learned, holes in the developmental process can lead to strabismus. Depending on the cause of the strabismus, the eye turn may be noted at different developmental phases in the growth of the child. As physicians, working to determine the development of the strabismus also helps us to make better decisions as to how to best treat it.
First, we must always rule out that there is any pathological reason that the eye turn has developed. Concurrent delays in other areas of development (motor & balance/vestibular skills in particular) must also be probed, as this can give us clues as to why the strabismus has developed. Infantile strabismus in particular can often have an underlying link to vestibular dysfunction. The accommodative, or focusing, system of the eyes must also be assessed thoroughly, as well as skills such as visual spatial & body knowledge (ocular proprioception). These are areas that Developmental Optometrists are skilled at evaluating.
Assuming judicious Vision Therapy is carried out, is there a variation in efficacy between the child who is born with strabismus and a child who develops strabismus at 2 years old?
Although the age of development in itself doesn’t determine the prognosis for strabismus treatment, infantile esotropia is often viewed as more difficult to treat, particularly if there is no early intervention implemented to help address any associated underlying holes in development that I mentioned previously. Since infantile esotropia develops earlier in life, the adaptations developed by the child tend to be more deeply imbedded than when a child went through a period of “normal visual development” prior to the strabismus developing.
At times, some may observe children wearing glasses and assume their vision is fully corrected when, in fact, the visual challenges may be a much deeper issue than glasses can address. When faced with this situation, how do you manage those assumptions?
One of the challenges with visual difficulties, it that parents can’t see what the child sees, and often doesn’t know that there is a problem. To further complicate the issue, the child doesn’t know to complain, as they assume that the see like everyone else. It’s important for parents to understand that eyesight is just one of about 15 visual skills required for a child to function efficiently in the classroom and in life.
First parents need to be educated and be their child’s advocate. So often I hear parents tell me that they knew something was wrong with their child’s vision, they just couldn’t put a finger on what it is. Parents need to know to trust their instincts and have their child evaluated, even if they’ve been told that the child’s eyesight is fine with glasses.
If a child is identified as having a vision disorder, I always do my best to help the parents see the way the child sees. I think that this can be very helpful for both the child and the parents, so that the parents can best understand the challenges that the child faces on a daily basis & how to best help the child.
Developmental Optometry, and by extension Vision Therapy, is a very powerful treatment modality producing positive results every day. If you could waive your magic wand, what changes would you make to improve our community even more?
The answer to this question is very easy. I would educate the community about the challenges & needs of children with visual dysfunction including the education of parents, education of teachers & professionals, and education of other physicians, including Pediatricians and Ophthalmologists. It’s so disheartening to hear parents constantly tell me, “I wish someone had sent me to your office sooner.” Unfortunately, I’m only one person and can only do so much to reach these individuals. Luckily, our patients are our best advocates and reach out to the community to help other families understand the difficulties that these children face. However, so many children are still being missed and left behind.
You are the mother of a beautiful little girl! Has parenthood changed your perspective at all in terms of treating other people’s children?
Like all parents, my daughter Elliet is truly my pride and joy. I don’t know if being a parent changes the way that I treat children, as much as it has helped me to empathize with the parents! Let’s face it, parenthood is hard work; wonderful & magical, but hard work. It is more exhausting than I even imagined. Parents are juggling so much, and when I talk to them about the difficulties that their child is having, I can talk to them as a mother who also deals with the challenges of balancing work, family, the kid’s school, homework & daily life.
I have always loved working with children, and it’s amazing to watch my daughter grow and learn. Every day is a new joy and a new challenge.
One quality that many Developmental Optometrists possess is immense compassion, and you certainly seem rich in this area. Where does your compassion come from?
I don’t know that I’ve ever met a Developmental Optometrist (or Vision Therapist for that matter) who wasn’t compassionate! It goes with the territory of what we do. As I mentioned, every child who walks through my door has a unique story & each one is important. I rejoice in their successes; but also, if they are unsuccessful, I feel unsuccessful.
If I look back, even as a young child, I have always loved animals and children. Before I wanted to work as a developmental optometrist, I wanted to work with animals. Empathy can be very powerful. I feel that much of my compassion comes from watching my mother work with children. My mother was a teacher who, year after year, gave all that she had to the children of her class; many who needed all of the love and nurturing that they could get. As a child, it wasn’t unusual that my family would be sitting in a restaurant, and a young adult would come up to us and say, “Mrs. Williams, I just wanted to thank you for all you did for me when I was in your class. You were the best teacher I ever had, and I will always be thankful for how you helped me.” Unfortunately, many things in schools have changed since then, and many teachers find the job less rewarding. But I’ve found a way that I can continue to touch the lives of children & adults in the same way that she did. I only hope that I can give as much to the children that I work with as my mother did when she was a teacher.
Some Closing Thoughts – A great thanks to Dr. McDermed for this interview. After meeting her and some of her team in Orlando at COVD’s Annual Meeting last year, it quickly became clear how compassionate and dedicated they all are for the well being of their patients. Please join me in wishing Dr. McDermed, her staff, and her family, the absolute best! 🙂