A Sit Down – with Dr. Mary Beck
A Sit Down – with Dr. Mary Beck
For the benefit of our readers, can you detail your background, history, and explain how you are involved in Developmental Optometry?
Hi! I am Dr. Mary Beck. I recently had a name change a year ago, so many people still know me as Dr. McMains. I am a Las Vegas Native with family roots in Southern California. I have been in practice for over 15 years and have always practiced in this specialty. I have worked directly and indirectly with some of the greatest docs in my profession and I have many great mentors. I was trained as a student extern by Dr. Robin Lewis in Chandler, AZ. My first position was in Dr. Carole Hong’s office in the Bay area (San Carlos, CA) and then I moved down to San Diego and practiced with Dr. Robert Sanet for about 6 years. In 2007 I moved to the Houston area when my sister was diagnosed with thyroid cancer and worked with Dr. Ann Voss, before my path led me to Austin, TX where I practiced with Dr. Emily Schottman. I have been the owner of Austin Eye Gym since 2012 which currently has two locations, one in North Austin and one in Cedar Park. I specialize in diagnostic, therapeutic & enhancement services for Neuro-Visual Function. I am unique in Texas because I have my Master of Education in Visual Function in Learning, and Board Certified by both the College of Optometrists in Vision Development (COVD) and the American Board of Optometry. I also provide continuing education to vision therapists, optometrists, sports physicians, occupational therapists, speech language pathologists and physical therapists through Minds on the Move, Concussion Health and V2Fit.
What led you to Developmental Optometry?
I knew I wanted to be an optometrist since I was 12 years old after my sister started working as an optician and I started wearing glasses and contacts. Before I graduated from the University of Nevada, Las Vegas, I researched optometry schools and received a video (VHS back then) from Illinois College of Optometry (ICO) that highlighted specialties within optometry, one of which was vision therapy. The concept intrigued me since I liked the idea of actually fixing visual problems instead of just compensate for them, so I sought out a Developmental Optometrist in Las Vegas. At the time, there was only one, Dr. Mary Carroll (RIP). I shadowed her vision therapist for an entire summer. I watched this very introverted 6 year old girl with an esotropia (eye that turned inward) who wouldn’t make eye contact turn into a gregarious, smiling 7 year old with straight eyes that loved to laugh and in wonder with the world. I knew then that I found what I really wanted to do. So, I researched schools with binocular vision programs and interviewed at several including ICO. Pacific University was where I finally ended up. Though at the time the corn fields I went through to find Pacific University that first day made me think of Children of the Corn and the optometry building was not very impressive back then since it was before the makeover, a then upperclassman, James Kundardt, was my tour guide and very gung ho on vision therapy and helped me realize that their program was a good fit for me. They had great sports vision program and vision and learning program (Thanks to Bradley Coffey, Alan Reichow, Paul Kohl (RIP) and Hannu Laukkanen).
After practicing for 15 years, is there a particular population of patients which seem to pique your interests?
I would say that I have two favorite patient populations: the first would be children with learning difficulties primarily related to vision, since there is nothing like watching a smart kiddo who is very defeated and thinks they are stupid, turn into a confident person who excels at school after vision therapy; the second would be patients with post-concussion syndrome since many can return to life, not just return to play after vision rehabilitation.
As you know, concussions have become a hot topic due to ongoing litigation by former players against the NFL in the last four years. One aspect to the conversation has been the significance of vision in the treatment of concussions. Can you elaborate further?
Concussion is definitely a hot topic. There is even a movie out in theaters called Concussion about Dr. Bennet Omalu played by Will Smith. I think the significance of vision in treatment is gaining momentum but still is not mainstream. Most professionals understand that vision is impacted by concussion, but do not have a firm grasp on how or when to treat vision problems secondary to injury. Vision in diagnostic testing has become very widely accepted and most diagnostic protocol use the triad of Vision, Vestibular and Cognition. There is so much diagnostic technology coming out with vision as part of its protocol, but hardly any in regards to treatment. Developmental Optometrists can be invaluable in filling this need. We are uniquely trained to neurologically rehabilitate the eyes, brain, body interconnection.
When presenting at the First Annual Concussion Symposium in 2013, did you feel the treatment of vision was in the forefront?
Not at all. As a matter of fact, many professionals were hearing about the importance of vision in treatment for the first time or had just heard about it and wanted to learn more. What I found to be gratifying is that the concept was so positively received by sports medicine physicians, ENTs, athletic trainers, physical and occupational therapists alike. Out of any area of my specialty, I would say my involvement in concussion treatment has really bridged the gap between optometry and medicine. Now it is not uncommon to have MDs including ENTs and neurologists refer to me.
Last year, Dr. Steve Devick was interviewed here and discussed the importance of the King-Devick Test as a sideline assessment tool. Since that time, it seems that many companies are looking for new and improved ways to assess concussions in a comprehensive and quick fashion. Is that your sense?
I think there are a lot of companies looking for a be all, end all tool for assessment that can be done without a highly trained professional so that coaches, parents, athletic trainers can get that quick diagnosis of concussion. Professionals need better tools to know WHEN to clear a patient. Most tools are focused on original diagnosis and are not good as benchmarks for recovery. The reality is that it has been estimated that 41% of athletes return to play too early.
Athletes are the main focus when thinking about concussion, but most concussions are not sustained by athletes but rather in the general population due to motor vehicle accidents, falls particularly in the elderly and workplace injuries.
There are some great diagnostic tools out there and they are getting better over time, some that need baseline testing and others that don’t. The value in these screening tools including the K-D Baseline Test is that it raises awareness of when concussion is likely or possible and helps to remove athletes from play a great deal more than in the past, particularly adolescents that are more prone to prolonged neuro-cognitive impairment particularly females. When some of the higher specialized tools are used in practice, it again helps professionals understand the possible multi-disciplinary approach that may need to be taken with individuals that sustain a concussion. But again, there really is not a good technology tool that can tell someone when a patient is ready to return to play/life.
A highly training professional is still necessary, particularly gatekeepers that are good at knowing when to refer to specialists and which ones are really key. Typically patients with concussion need more than one professional. There is still no one tool that diagnoses a concussion because just like any head injury, when you have seen one patient with concussion, you have seen one patient with concussion. Each individual has a different degree of injury, symptomology and recovery prognosis depending on how the injury was sustained, age, gender, patient history including previously sustained concussion and risk factors. That means that treatment must also be highly individualized.
What is V2 Fit?
V2Fit was created by Bridgett Wallace, DPT a vestibular specialist and myself in 2015 to provide continuing education, diagnostic and treatment protocol for concussion and post-concussion syndrome including diagnostic kits for practice, training protocol and software training modules. V2 for Visual and Vestibular. We are in our developmental stages but currently provide most of our continuing education live and via webinars in partnership with Concussion Health. We are creating a concussion certification program that includes labs, practical demonstration and comprehensive testing to achieve. We hope that it helps professionals across many disciplines have a similar model for concussion diagnostics, treatment and management, which is much needed. Our goal is for professionals to know how to individualize the management of their patients and clients but provide them with tools and education to make it easier.
Part of your curriculum discusses patients diagnosed with post-concussion syndrome due to lingering signs and symptoms which are mostly due to vision dysfunction simply because it was not addressed. Do you see this landscape changing?
It is disturbing that visual disturbances make up 49% of the most commonly reported symptoms and that balance problems are 43% of the most commonly reported symptoms and both are not often directly treated, particularly vision. The goal of V2Fit is to change that landscape and address the root of those symptoms. I am encouraged because there are several concussion specific clinics out there are incorporating vision in their treatment and have a Developmental Optometrist on site to oversee it. Most professionals, including my own profession, do not know the best time to incorporate vision rehabilitation and at what level when also being mindful of vestibular and cognition therapy.
In your opinion, what can we do as the community of Developmental Optometry to help promote ourselves within the community of concussion management?
Get educated, get trained, get involved and get to know your paraprofessionals (especially your vestibular specialists)! There is a great need for Developmental Optometrists in concussion management.
In a perfect world, how should we treat a player flagged by the return to play protocol?
First, not all players should have the same return to play protocol. Diagnostic protocol should be in place to understand when and how to intervene whether it is vestibular, cognitive, somatosensory, affect or vision. Assessment should use a graded symptom checklist that at a minimum includes fogginess, headaches, nausea and dizziness. From there, return to play protocol should be created. Treatment should also use a graded, step-wise approach that also uses a graded symptom recording system to help determine when to advance treatment. Treatment should work from static to dynamic, low balance load to high balance load, work from no exertion to exertion using guidelines like the American College of Sports Medicine (ACSM), low cognition to dual tasking and should incorporate VOR and oculomotor either to rehabilitate or use as a load.
Lastly, with all the discussion of concussions, many parents have become nervous about their kids playing contact sports due to fear of their children becoming seriously injured. If parents of your patients present you with a question as to whether or not to allow their kids on the field, what’s your response?
I tell parents to be familiar with the Return to Play Law in their area. ALL states have laws in place at this point. I encourage all parents to get baseline testing done including K-D Testing and something like ImPACT testing each year. Since they are already in my chair, I have basic vision diagnostics done and history. I also educate them that most concussions do not have a loss of consciousness and whenever injury occurs that could even be a whiplash like injury, to be screened. When in doubt, get tested and work with someone who works with concussion regularly (sometimes this is not their pediatrician). The worst thing for long standing injury is to return to play too soon, as 92% of repeated concussion occurs within 7-10 days of the first one. It has been shown that adolescents can have altered cerebral blood flow up to a month after injury and require at LEAST 7 days for cognition to return to baseline and symptoms to resolve. If concussion is diagnosed and even if suspected, REST is the cornerstone of concussion treatment. Rest means no school, no texting, Netflix, reading, computer, gaming, TV, movies, etc. (yeah, I know. Not so easy). The goal is no sensory stimulation. Too bad we can’t come up with a medical protocol to knock someone out for 3 days (just kidding). I also impress on parents and patients that safety gear that is sport specific (like mouthguards and face shields) is extremely important. I also lecture on the use of helmets for play like biking, skateboarding and horseback riding, since head injury can be more prevalent in those situations.
I have told parents with a child that has already sustained multiple concussions that they have a high risk of permanent or neurological damage. Ultimately, it is the parents’ decision on what they do with that information.
Some Closing Thoughts – a great thanks to Dr. Mary Beck, who also happens to be my boss, for taking the time out to do this interview. For a long time, Dr. Beck has been interested in improving both herself and her staff and continues to find new methods for bringing excellence to our clinic and our patients. Her commitment to her patients is unsurpassed, making working for her a delight! Please join me in wishing Dr. Beck, her patients, her family, and her staff (especially, her staff!!) the absolute best! 🙂