A Sit Down – with Dr. Mitch Scheiman
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. Mitch Scheiman
For the benefit of our readers, can you detail your background and explain how you are involved in Developmental Optometry?
After graduating from the New England College of Optometry in 1975, I completed a residency in vision therapy at the State University of New York College of Optometry. I had the opportunity to work with outstanding mentors such as Martin Birnbaum, Arnie Sherman, Irwin Suchoff, Nat Flax, and Jeff Cooper. These individuals inspired me to pursue a career with an emphasis on vision therapy. Although I had never considered spending my professional career as a full-time optometric educator, my experience at SUNY also gave me the opportunity to experience the challenges and benefits of teaching. After completing my one-year residency, I returned to the New England College of Optometry as a clinical instructor for 5 years. In 1982 the Pennsylvania College of Optometry offered me the opportunity to serve as the Chief of the Pediatric/Vision Therapy department at the College and I remained in that position for close to 30 years. In addition, I have maintained a part-time, vision therapy specialty practice for about 25 years in the suburbs of Philadelphia. In the last 15 years I have become very involved in research with a primary objective of working with a group of fabulous co-investigators to produce quality evidence of the effectiveness of vision therapy for various vision problems.
In addition to my roles as an optometric educator and practitioner specializing in pediatrics and vision therapy, I have contributed to the developmental optometry and vision therapy literature with 4 textbooks and many journal articles.
What led you to Developmental Optometry?
Since my third year of Optometry School, after my first course in vision therapy, I have been fascinated by the fields of Developmental Optometry and vision therapy. I find this area of optometric practice to be so much more challenging and exciting than any other topical area. The ability to make significant changes in an individual’s visual functioning leading to life-long improvements in ability to function in school, work, sports is extremely rewarding. The days go quickly and each patient represents a new and interesting challenge. At the end of a day of patient care I sometimes just sit down and smile and feel a great deal of satisfaction about my decision to specialize in developmental Optometry and vision therapy.
Conducting research seems to be a very labor intensive side of patient care. Why did you choose to do down that path?
As a young optometrist with a specialty in vision therapy I was constantly faced with the challenges of defending our field back in the decades of 1980s and 1990s. I patiently waited for the more senior members of the professions to produce the necessary research that would support the efforts of Developmental Optometry. At some point it became obvious to me and a group of similar thinking colleagues, that this would not happen and since we were now becoming the “senior” members of the professions we felt a responsibility to develop and implement of studies to demonstrate the effectiveness and benefits of vision therapy. This was quite a transition for me and my colleagues (CITT Investigator Group). Our group of optometric educators with a strong interest in vision therapy began meeting and planning our studies in the mid- 1990’s. Your are correct that research is labor and time intensive and it took us many years of hard work to develop and complete a series of necessary small, pilot studies until we were ready for grant application submission to the National Eye Institute. There were many disappointments along the way, but we were committed to filling the gap in the literature and we are thankful that we were eventually funded on several occasions by the NIH/NEI.
As the principal investigator for the CITT study which was published in 2008, can you explain how that study was born and what was the motivation for its creation?
Our CITT Investigator group first formed in 1995 at a meeting sometimes referred to as “research summer camp” sponsored by the American Optometric Association and American Academy of Optometry. At this meeting our group decided that this gap in the literature (limited data of the effectiveness of vision therapy) needed to be addressed and that we were going to be the group to do so. Some of the other key investigators in that original group included Michael Rouse, Harold Solan, Len Press, Susan Cotter, Jeff Cooper, Jonathan Holmes, and Leslie Hyman. The group developed a strategic plan to accomplish our goal of being funded by the NEI to conduct an effectiveness trial of vision therapy. We then spent almost 7 years completing the pilot studies necessary to pursue NEI funding. We were first funded by the NEI in 2002 and this led to publication of our first three randomized clinical trials in 2005. Our large-scale CITT study was funded in 2004 and led to the 2008 publication to which you referred. Most recently we were funded again in 2014 for the CITT-ART study (CITT Attention and Reading Trial)
In a nutshell, what did the CITT study show?
The NIH study was a collaborative study with both optometrists and ophthalmologists involved in 9 sites throughout the United States. The study included 221 children ages 9 to 17 with symptomatic convergence insufficiency (CI) and compared different forms of treatment, including home-based pencil push-ups, home-based computer vision therapy, and placebo therapy. After 12 weeks of treatment, nearly 75 percent of the children that were given office-based vision therapy (OBVT) along with at-home reinforcement procedures achieved normal vision or had significantly fewer symptoms of CI. It also found that two commonly prescribed home-based therapy programs were no more effective than placebo treatment.
This study showed that, once diagnosed, CI can be successfully treated with OBVT by a trained therapist along with at-home reinforcement and that OBVT should be the first-line treatment.
You now have a new project, the CITT: Attention and Reading Trial, correct?
Yes, our CITT investigator group is extremely excited that we were once again be funded (May 2014) by the National Eye Institute (NEI) of the National Institutes of Health (NIH). In this era of funding cutbacks and extremely competitive application process we are so pleased that the NEI/NIH and all the reviewers felt that our group of investigators and this topical area were worthy of being funded. This is a testament to the appreciation of the importance of this topic and a respect for the outstanding group of investigators in the CITT Investigator group. The total fund is about $8 million and the study which begin recruiting recently is expected to last until 2019.
How is this new study different from the CITT study completed in 2008?
The first CITT study was designed to study the effectiveness of various types of vision therapy for improving the symptoms and clinical signs of symptomatic CI in children. We did not look specifically at the effects of treatment on reading. In this new study, we now know the most effective treatment for symptomatic CI in children (office-based vision therapy), and will evaluate the effect of treatment on reading and attention in children with symptomatic CI.
Can you briefly describe CITT-ART?
The CITT-ART is a designed to study the effectiveness of vision therapy for improving reading and attention after the treatment of convergence insufficiency in children 9 to <14 years of age. I am the Study Chair, Susan Cotter, OD and Marjean Kulp, OD are the Vice-Chairs, and Lynn Mitchell, MAS is the Principal Investigator of the Data Coordinating Center and participating clinical study centers include:
|Clinical Study Center||Investigator(s)|
|Bascom Palmer||Susanna Tamkins, OD|
|Children’s Hospital of Akron||Richard Hertle, MD|
|Ohio State University, College of Optometry,||Marjean Kulp, OD , MS|
|NOVA – College of Optometry||Stacey Coulter, OD|
|Pennsylvania College of Optometry at Salus University||Michael Gallaway, OD|
|Southern California College of Optometry at Ketchum University||Susan Cotter, OD, MS|
|State University of New York, College of Optometry||Jeffrey Cooper, OD, MS|
|University of Alabama, Birmingham College of Optometry||Wendy Marsh Tootle, OD|
|CITT ART Reading Center||Christopher Chase, PhD|
The CITT-ART was designed to find out whether therapy for CI improves reading and attention. Children with CI have many more symptoms when reading and show worse attention than children without CI. We know that CI therapy improves these symptoms and we have some early evidence that treatment also results in improvements in reading and attention. However, to know for sure we need to study this question in a larger group of children and some children need to receive a harmless control therapy that is not designed to treat convergence insufficiency. This study is being conducted at 8 sites across the United States and is funded by the National Eye Institute, which is a part of the National Institutes of Health. About 324 children will take part in the study.
Why should parents consider volunteering their children for this study?
We are now recruiting for this study and hope to interest readers to participate. The best reason to consider volunteering your child for the CITT-ART is to be part of a national study designed to provide answers about how treatment of CI affects reading and attention. All parents receive a summary of the reading test results and children will also receive treatment for CI at no cost.
How can parents find out if there is a study site in their area?
Parents can receive further information please go to the CITT-ART website: www.citt-art.com
One common rebuttal parents encounter from those outside Developmental Optometry is that Vision Therapy lacks the statistics and research to be considered effective. What’s your response to these ideas?
While that might have been a valid argument a decade ago, it is simply no longer accurate, at least for conditions such as CI and accommodative (focusing) disorders. Until recently, clinicians seeking evidence regarding the effectiveness of treatments for children with symptomatic CI had limited quality data to support any available treatment option. The studies that have been performed by the CITT Investigator Group and published since 2005 demonstrate that home-based pencil push-up therapy and computerized therapy combined with pencil push-ups are significantly less effective than office-based vision therapy. These studies used the “gold-standard” randomized clinical study design and were published in well-respected journals. In addition, the highest level of the effectiveness of a clinical treatment method is evidence is referred as a ”Systematic Review”. Such a review is now available on the Cochrane Collaboration website. I encourage your readers to review this publication.
The CITT Investigator Group also published data from a randomized clinical trial demonstrating the effectiveness of office-based vision therapy for accommodative (focusing) problems.
In addition, quality evidence is now available from researchers using objective eye movement recordings that minimize the subjective nature of clinical measurements. Dr. Tara Alvaerz from the New Jersey Institute of technology, and Dr. Ken Ciuffreda and colleagues from the SUNY College of Optometry, have published the results of several well-designed studies that clearly demonstrate that office-based vision therapy improves vergence, accommodative and eye movement function.
Thus, anyone suggesting that quality data are not available is just not familiar with the recent literature. More work remains to be done, particularly with eye movement and visual processing disorders, but for binocular vision and accommodative disorder convincing evidence is now available.
There seems to be a movement forming within Developmental Optometry whereby we are focusing less on defending our profession against naysayers, and instead, putting energy into embracing and nurturing the positive relationships with those outside Vision Therapy. Do you think this is a sway in the proper direction?
Both approaches are important and should be pursued. I think it is wise embrace and nurture positive relationships with those outside the field of vision therapy, but there continues to be a great need for the pursuit of research and quality evidence. Those people and groups that already have positive feelings about Developmental Optometry will feel even more comfortable when we produce additional quality evidence of the effectiveness of vision therapy.
Lastly, I was in the audience the year you stood up at COVD’s Annual Meeting to announce the findings of the CITT study, and remember the entire room erupted with a standing ovation. Can you describe that day, and that experience, from your perspective?
Well, this question certainly brings back memories of that very emotional moment for me and the rest of the CITT Investigator Group that were in the audience that day. There is no doubt that it was the highlight of my professional career and I assume the same was true for the other CITT investigators in the room. That moment represented the culmination of almost most 15 years of very hard work by 90 investigators around the country. The realization that there was such a high level of interest, excitement, and appreciation of our work made all of our efforts worthwhile and is a moment I will never forget.
Some Closing Thoughts – A great thanks to Dr. Scheiman for taking time out for this interview. Clearly he is a passionate and dedicated member of our VT family!
As many of you have heard by now, this interview is the beginning of our #cittart hashtag party, which is hosted by COVD and in cooperation with the COVD Blog and VisionHelp Blog. Our party, which is designed both to recruit kids into the new CITT-ART study and to raise awareness about Vision Therapy, starts today and will run all week. Please help us by re-posting this, as well as any other VT related article on your favorite social media sites (Facebook, Twitter, Tumblr, Pintrest, Instagram and more!) and hashtag each post with #cittart
Thanks again to Dr. Scheiman for his incredible work. Please join me in wish Dr. Scheiman, his staff, and his family the absolute best! 🙂