Written By Guest Blogger: Jessica Zwilling, COVT
Everyone has their own “style.” We hear this and say this often in our world of Behavioral Vision Therapy. As a COVT who has worked for different doctors over the last 20 years, I can attest to that fact. Optometrists and Therapists alike, all have their own style in the VT room. Of course, we all learn the broad outline of how to treat different visual disorders and which activities to utilize and in what order, but I believe that it is a rare find to have two VT practices practicing the same way. Of course, we usually achieve the same end goal, just not always in the same way. Why is that?
I can’t speak with authority on this, but I assume that heart surgeons across the country perform certain procedures in the same way just as dentists across the country fill cavities the same way. Of course, there are exceptions with everything from the type of patient to the tools available to the doctor, but in general, there seems to be a little more uniformity within other fields of healthcare. I think Vision Therapy’s lack of uniformity can be both our rise and downfall in the eyes of other healthcare providers and educators.
Recently, we had a patient come for an evaluation who showed me this lack of uniformity in her notebook that she brought with her to the last SIX, yes, SIX, vision exams. The patient is an adorable, good natured, 25 month old little girl with Triple X Syndrome and intermittent exotropia in one eye (divergence excess-type). My doctor found no blaring refractive error or signs of amblyopia at this time. Her syndrome doesn’t seem to slow her down much, as she is determined to do everything her twin brother does. She does toddle around more like a 16-18 month old, but she does talk some and overall seems to be a cooperative and happy little girl. Of course, my Doc recommended VT, and why not? There are tons of things I can do with this kid, and lots the parents can do at home.
After scheduling our first VT session, Mom pulled out the notebook and gave me the brief history of the other six doctors’ recommendations. #1 and #2 were both pediatric ophthalmologists who both recommended eye muscle surgery along with the scare tactic that it should be done right away. #3, a Developmental OD, found no eye turn at all and sent them on their way. #4, a Developmental OD, sent the parents home with a TBI unit to use during the night while their daughter was sleeping. #5, a Developmental OD, told the parents that they primarily use computer orthoptics for treating vision disorders and to come back when she is 8 years old. #6, also a Developmental OD, recommended yoked prism (not sure what kind) for full time wear and some convergence training.
Now, keep in mind, this is all the parents’ wording and I have no way to find out all the details of all the recommendations without calling each doctor personally. I am so not going there, nor do I need to. I’m not one to say that my way is better or worse than anyone else, and I certainly am not here to say that anyone was right or wrong. Remember, we all have our own style and skill set with which we are most comfortable. My concern is that the parents, now at eye doctor #7, are confused and frustrated by conflicting or differing recommendations, yet hopeful and determined that they will find someone to help correct their 2 year-old’s vision.
Are all these different opinions helping or hurting our field? Are cases like these the reason ophthalmologists say we practice voodoo when the family goes back for a follow-up? Are cases like these the reason so many pediatricians say Vision Therapy doesn’t work?
Should we strive for more uniformity of treatment plans within our field? VT docs learn about standard treatment plans in textbooks, clinic, and during residency. Often doctor’s will grow into their own VT style through years of clinical practice, tips from a mentor, and shared ideas within our community. A therapist’s knowledge base usually comes directly from the doctor under which they work and from any independent reading they do. There are many areas to which many therapists never get exposed. We have lots of gold standards in our field that we all use from Brock Strings and vectograms, to accommodative flippers and Marsden Balls. Yet, one can go visiting from practice to practice and find so many variations. Some incorporate primitive reflex training, vestibular stimulation, syntonics, and even yoga!, while others primarily use computers, and Hart Charts for most of the training.
I think it’s wonderful that we have so much diversity, open mindedness, and creativity within our field, and that we are all so willing to share our different approaches with one another. However, if you put yourself in the shoes of parents, teachers, and other healthcare clinicians, Vision Therapy can be down-right confusing! There must be some middle ground.
That’s my concerned rant, for the moment. I don’t have the answers, just the observations. I’d love to hear input and opinions from our readers!
“We make our discoveries through our mistakes; we watch one another’s success; and where there is freedom to experiment, there is hope to improve.” – Arthur Quiller-Couch