A Sit Down – with Thomas Lenart M.D., Ph.D.
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. Thomas Lenart
For the benefit of our readers, can you tell us about your background and explain how you came to be involved in the world of vision care?
My educational and medical background include matriculating from Hiram College with a B.A. in Biology in 1981, followed by two years (1981-83) serving in the Peace Corps as a High School Physics Teacher in French West Africa (the country of Benin). Following a one year stint as a Physics Laboratory Instructor at Hiram College I spent a year as a Ph.D. graduate student at The Johns Hopkins University in the Department of Biophysics. In 1986 I transferred to the University of Pennsylvania Department of Biophysics and began there as a student in the Ph.D. program. In 1988 I was accepted into the University of Pennsylvania Medical School combined degree program. I completed my Ph.D. in Biophysics in 1993, and completed the Medical Degree in 1994 both from the University of Pennsylvania. I then completed a Transitional Medical Internship at Lankenau Hospital in Wynnwood, Pennsylvania in 1995. I did a three year residency in the Department of Ophthalmology at The Mayo Clinic in Rochester, Minnesota, completing it in 1998. I then completed a fellowship in Pediatric Ophthalmology and Adult Strabismus at Emory University in 1999. I have been practicing in private practice in Redmond, Washington since August 1999, now into my fifteenth year of private practice. The patient mix in my practice is ~95% children and 5% adults. My practice name is Eye Care Specialists Northwest. I am in the division of The Children’s Eye Doctors. I co-manage many patients with Dr. Torgerson.
Under what circumstances, or for which diagnosis, do you feel VT to be effective?
Here I think we need to look at the effectiveness of VT on a case by case basis. For example, convergence insufficiency intermittent exotropia is a situation quite amenable to management by vision therapy. Large angle infantile esotropia may not be as amenable to being managed by vision therapy. Does that mean there is no role for surgery in CI X(t) or no role for VT in large angle infantile ET? No, not necessarily. This is the heart of collaboration where the Developmental Optometrist and Pediatric Ophthalmologist can look at how best to treat the patient given the disease and sometime more importantly the families needs and circumstances.
As a supporter of Vision Therapy, you’ve placed yourself in a very small minority among your colleagues. What have you come to understand about VT that creates the opposite opinion from the vast majority of your profession?
It is hard to speak for the collective, because with regard to Vision Therapy, there are a vast number of opinions among my colleagues. The bases of these opinions can include (but are not limited to) the doctor’s formal training, anecdotal experience with “Vision Therapy,” and the regional as well as national influences. For instance, with regard to my situation, my formal training and national influences would lean towards negative support of vision therapy, whereas some of the regional influence and definitely my anecdotal experience with “Vision Therapy” put a very positive light on it.
One common argument coming from Ophthalmology is that Vision Therapy lacks evidence of success, or lacks double blind studies proving its efficacy. On the contrary, studies (such as CITT) have demonstrated how effective Vision Therapy can truly be. How do we get over the proverbial “hump” in changing this perception?
I think the studies have done it already. The science is clear, the results are documented nothing further can be done to present the facts. However, a person has the right to choose to accept or not what the facts present, just as in any other area of practice. In addition, there is the issue of what “Vision Therapy” means to the person whose perception hasn’t changed given the results of the studies (such as CITT).
One common argument from naysayers is that Vision Therapy doesn’t “cure” Dyslexia or ADD/ADHD, which is true. However, what is not commonly shared is that visually related learning challenges can have similar symptoms to these aforementioned afflictions and patients enrolled in VT are quite successful in remedying these challenges. How can we improve the process of differential diagnosis in this area?
Simply put, education. I think eye care specialists (Ophthalmology and Optometry) in general have difficulty understanding the nuances in this area. In addition, published data in peer reviewed journals that are read by many in both fields would be beneficial.
Often parents are left in a whirlwind of confusion in regards to their child’s visual care. Their Pediatric Ophthalmologist may be recommending strabismus surgery or full time patching, while their Developmental Optometrist may ask them to hold off on both ideas until some judicious Vision Therapy is completed. While neither profession is necessarily wrong, the divergent advice can be frustrating. How do you help parents resolve this situation?
Stronger national collaborations between Developmental Optometrists and Pediatric Ophthalmologists…at least for starters. It is only when the Developmental Optometrist and Pediatric Ophthalmologist can talk openly and actually discuss the patient’s situation with delivering the best patient care in mind that a solution can be generated. Absent that, I think it is very difficult for parents to know what to do, quite frankly.
Do you feel that strabismus surgery and Vision Therapy, when done in conjunction, can offer the patient the best opportunity for a positive outcome?
Difficult to generalize as I believe there are situations in which VT should be the primary intervention, other situations in which surgery should be the primary intervention, yet for the majority of situations a combination may be best.
As a population of patients – yours and mine alike – it seems like we would be so much better off, and helping so many more people, if we would all just work together and perhaps open our collective minds to the benefits of each other’s services. It seems so simple, and yet, so far away. Do you feel like this paradigm shift is ever possible?
Yes it is possible. As we approach this body of doctors who we would like to persuade to consider working together with Developmental Optometrists, we need to think about a strategy that will invite them into the fold willingly. And push hard to that end.
What is the answer? Quite honestly, I am not sure, but let’s do everything we can to not alienate them. That would be the wrong direction.
It has taken 5-7 years of talking with Nancy to get to this point. Now I can have some very candid and raw discussions because we trust one another. We may not even completely agree in the end but that is how I see the this moving forward. Lots of discussion.
COVD’s Annual Meeting is coming up in October and you’re scheduled to co-present with Dr. Torgerson, which surely will be a well attended lecture. Can you tell us why you’ve decided to speak at COVD, and maybe offer a little insight as to what we’re in for?
It will be a rewarding experience for all who attend. Even if you walk into the room anticipating that you’ll disagree with what Dr. Torgerson and I are doing, you will come away feeling inspired that those two have something going which is unique and extraordinarily positive for their co-managed patients!!
As we constructed this interview, the animosity and dissension between our professions became clearer than ever to me, making your willingness to do this interview an incredible step towards progress, and I thank you greatly for that. As a profession, how can we help you continue to blaze a trail towards unity within the world of vision care?
Many of the questions Developmental Optometrists raise are good but they are somewhat confrontational and are the “heated” issues that have and will continue to create the deep crevasse between our fields.
As a football coach, I need to understand my players to get out of them what I want. When they don’t perform in the manner I ask, then I have to go back and consider how can I better coach them? Yelling at them to block better, give more effort, etc does not help them improve…it just discourages them from wanting to play at all. So when the players are not playing well, then my approach to coaching needs to change (or at least be evaluated).
I don’t know the best solution for relaxing the animosity and dissension between our fields, but perhaps we need to uncover and discover the efforts that achieve what we want, namely collaboration. Maybe we could put aside some of the questions that cause the most dissension between our fields and begin to look at where we agree and build on that.
Lastly, if we could gather all the Developmental Optometrists and all the Pediatric Ophthalmologists into one room with you as the keynote speaker, what message would you deliver?
Keep an open mind, have lots of patience, ask lots of questions and be disciplined to understand the “other side” for the sake of your patient care.
Some Closing Thoughts – A great thanks to Dr. Thomas Lenart for agreeing to do this interview, and for the time spent collaborating. Clearly, Dr. Lenart is a supporter of Vision Therapy and is working hard to open new doors for co-management between Developmental Optometry and Pediatric Ophthalmology. It is with an incredible amount of gratitude and respect that we anticipate his presentation with Dr. Torgerson this October in San Diego, and for me personally, it is an honor that he is allowing this blog to help him further the dialogue. He is certainly a class act! Please join me in wishing Dr. Thomas Lenart, along with his colleagues and his family, the absolute best! 🙂
Honorable Mention – A special thanks to Dr. Nancy Torgerson and Dr. Leonard Press for their assistance with this project.