Yesterday, the New York Times Magazine published a lengthy article online about vision therapy (VT). It presents some very compelling cases of patients who have received vision therapy and observed the changes it can produce when needed. Many of the comments are also from parents who have children who have lives changed from VT.
It also delves into the controversy. As a provider of VT, I feel that this article fairly characterizes how the multiple sides involved view this issue. It is accurate to say that most pediatricians and ophthalmologists are opposed to vision therapy and the parents who have experienced it often become very supportive. There is often very little middle ground.
I believe very much that patients can have vision problems that interfere with various aspects of their life and VT is the appropriate treatment. However, when I am making recommendations to patients, it can be difficult to find the line between over-promising potential results from vision therapy and failing to provide a valuable and needed service for a diagnosable problem. Often, even with the best available data, we may not know just how well a patient will respond. After all, there are no guarantees with any medical intervention; we can only do our best with the information we have.
I encourage all who are interested in vision and vision therapy to visit the website of the College of Optometrists in Vision Development to learn more about what is known about vision and vision therapy. Of course, you can always call our office or Ask Dr. Nate.
See Well!
Nathan Bonilla-Warford, OD
Bright Eyes Family Vision Care
Located in the Westchase area of Tampa.
Connect:
I'm glad that vision therapy is getting coverage in the news. It can do so much for patients that have vision troubles. The treatment takes time and I think that is what causes the consternation among ophthalmologists. There are plenty of studies that show the efficacy of vision therapy.
Can you answer why the Academy of Pediatrics would reject vision therapy for learning disabilities if there is good scientific evidence that it works? Surely the Academy cares about kids as much as you optometrists do, no? Why in the world would they place kids in harm's way by rejecting solid, scientific evidence that it works? After all, the medical community has accepted acupuncture and bio feedback and other alternative treatments when there is good evidence that it works. And the Academy gains nothing by rejecting vision therapy- pediatricians do not treat learning disabilities.
So, either the Academy is engaged in some kind of conspiracy, or, the scientists of the Academy are a bunch of dopes and don't understand how to analyze scientific studies, or– maybe there aren't good scientific studies out there after all.
I'm not saying it doesn't work. The problem is, no one can say it does work, as there are no good scientific studies out there to prove it. All we have are anecdotes- and for every parent who swears by it, there's a parent who says it's worthless- just look it up on the internet, and you'll read about all the failures.
After all these years of vision therapy, it kinda seems weird and suspicious that a definitive scientific study has not been performed to put the issue at rest. After all, we read all the time how, for example, heart stents are better than bypass, or one drug is better than another, or how lumpectomy is better than mastectomy etc. These studies take years, create a lot of data, and are published in reputable journals and picked up by newspapers. Where are similar studies in vision therapy? Nowhere, it seems.
When I see a medical doctor about a treatment or surgery, they can almost always say definitively what the odds of success are, whether “A” is better than “B” etc., since they have good studies to guide them. For example, after a heart attack, they know that a beta blocker will prolong my life, based on a study done several years ago. Or that aspirin will reduce my chance of a stroke- again, it's based on scientific studies, following patients for many years, and seeing the results of those on aspirin and those off aspirin. There's no controversy about these things, since definitive scientific studies have been done.
So why is it that after so many years of vision therapy, it's still a controversy, with those who make money off it stating that it works and that there's plenty of evidence, and those who make no money off it stating that there's no proof?
To answer some of your questions and respond to some of your comments:
You asked: “Can you answer why the Academy of Pediatrics would reject vision therapy for learning disabilities if there is good scientific evidence that it works?”
The answer to that is both simple and straight forward. The first is “politics” and the second “if you say something false often enough, people start to believe it”. The AAP folks were usurp by their pediatric ophthalmology colleagues so that they, a separate organization, could appear to support a statement that is both disingenuous and false. The false statement is that optometry uses vision therapy to directly treat learning disabilities….we do not treat learning disabilities. We state that we do not treat learning disabilities. We treat Learning Related Vision Problems.
As far as caring about children as much as we do…that is true except for those that hate optometry in an irrational manner. Those that perform acupuncture/bio feedback do not have a direct medical practitioner aligned against them. I recently read a text on alternative medicine…and there are still those MDs who are very biased against non-MD treatments or therapy NOT controlled by MDs.
The AAP is not in a conspiracy nor are the scientists dupes….but their organization does appear to have been co-opted …. even when the science is clear there are MD Luddites out there that still do not believe or want to believe.
Please see “Maino D. An Open Letter to David K Wallace, MD, MPH (and other disbelievers and holders of outdated and biased opinions and beliefs). Optom Vis Dev 2008;39(4):178-18”
at http://www.covd.org/Portals/0/An%20Open%20Lette…
Vision therapy works just fine. There are numerous studies that shows it “works” for convergence insufficiency problems and other disorders of vergence, focusing problems and eye movement dysfunction. It works for amblyopia (lazy eye). I
We do not treat learning disabilities….but there is a great deal of new evidence being published that “yes” vision does has something to do with learning….and vision problems affect learning. We fix those problems. As far as vision therapy not working for all….well, what therapy does? But it does work for most. BTW there appears to be many more “success stories” on the internet, than those of failure.
The studies you seek are in PubMed and other journals…if you bother to look and know what to look for…go to http://www.covd.org/Home/ResearchWhitePapers/ta… for a listing of some of that research.
I'm a Professor at a leading optometric institution and science guides what I teach….you seem to be blinded by science. There is NO definitive science on anything…in fact if science tells us anything…it is that more science always needs to be done…you do know that “stents” may actually cause more problems than they cure right? You do know that aspirin can cause its own problems? And that since we are all uniquely individual…that one treatment applied to me may not work the same as it does on you, right?
You note that, ” There's no controversy about these things, since definitive scientific studies have been done.” Go back and do your homework…you missed something along the way.
Why has it taken so long to show vision therapy works? Why do some misguided souls still deny the outcomes of the clinical trials? Why do ophthalmologist who now use “accommodating IOLs” use vision therapy (they call it perceptual learning) to teach their patients to focus? Have you heard about the scandal involving climate change…where one group stopped the publication of papers presenting an opposite view? Unfortunately, there may be many reasons why….many having nothing to do with the science.
1. If the AAP has been co-opted as you say, then why in the world should I think you and Optometry are not co-opted? What makes you think you are more credible than the AAP? This line of thinking is so bankrupt- you can give that answer to anything, and any answer that can be given to anything is no answer. You think we are so gullible as to think that you are the good guys, utterly immune from political or financial pressure, but the pediatricians are not? You sound like those talking heads on TV, where on one channel all I hear is how evil and corrupt the Democrats are, and the other channel where all the Republicans are evil and corrupt. Who doesn't know by now that ALL politicians are corrupt? Do you have any clue how many Democrats are under investigation? Answer- about as many as Republicans.
2. I am not talking about proof of VT for CI. I am talking about proof of VT for learning disability. And my question is the same- why don't optometrists conduct a study to prove it works? What are they waiting for?
3. Your comments about science are outrageous. Of course science “proves” nothing. Nothing in this universe can be “proven”. All science can do in medicine is help us decide which treatment is better. All science can say, for example, is that there is a 100-1 chance that stents are better than bypass. And most normal people will take comfort in that and choose stents. Does that mean stents are always better? Of course not.
According to your twisted logic, why bother doing any scientific studies at all? After all, it proves nothing, right?
Scientific studies are not perfect, but they certainly are the best way we have to try and figure out what works or what is better. Everybody knows aspirin kills people. But if there is a good study that demonstrates that aspirin can reduce your odds of a heart attack by, say, 30%, wouldn't you be grateful for that study, so you can AT LEAST MAKE AN INFORMED DECISION? Of course you would. So why not do the same thing with VT for learning disabilities? Conduct a study already so that parents can make an informed decision. You guys are doing VT for learning disabilities for years now, and you're still relying on anecdotes.
Parents take their children with cancer to a doctor, and the doctor can cite one study after another to help decide which chemo combination works best. That's science for you, and parents are grateful. But when parents take their kids to you for VT for learning disability, all you can say is how great it works in your office, and that there's no good scientific study, and the pediatricians and Ophthalmologists also say there's no good scientific studies, but don't believe them cause they are all co-opted by the scientific/medical community's bias blah blah. Parents really ought to stop and think and demand more proof from Optometrists before subjecting their kids to what could just be cash-draining nonsense, and parents should finally demand scientific proof. And again, I'm not talking about VT for CI. I'm talking about learning disabilities.
Larry…I'm not sure why you've gone off on such a tangent here…nor why you feel so strongly about the topic. Optometry does NOT treat learning disabilities. Please, repeat after me….vision therapy does not treat learning disabilities. We diagnose and treat the vision problems that can mimic learning disabilities and/or cause reading or other academic pursuits to be harder than it needs to be…and yes, the CI research is relevant to this discussion…because we can treat CI very successfully.
Thanks for admitting that science is imperfect…but the best we have available and that politics/money and other issues can cloud/taint reality.
I think your over the top emotional connection to this issue is clouding your judgment a great deal. I hope you can accept the science that supports VT for learning related vision problems….I can get you some references if you want…read the studies…calmly…without bias…and then let me know.
sorry- didnt mean to get too heated. but i get very irritated when smart people “play dumb”.
of course optometrists don't treat learning disabilities! they treat vision problems related to learning disabilities. that is exactly what we are talking about, and you know it.
And your comments on science is also “playing dumb”. We all know it's not perfect, and we all know that scientific studies cannot apply to every patient. So what? Again- a parent who takes his kid to the doctor for cancer treatment wants a doctor who is familiar with the latest SCIENTIFIC studies, so they can figure out what is the best way to go. They don't want a doctor who only relies on his hunch, or what has worked best in his experience. According to your logic, why bother with any scientific studies at all? You'll have the same silly answer- it's not perfect, it cannot be applied to every patient etc.
So we are left with the same questions you haven't answered:
1. Why in the world would I believe you to say that Pediatricians are co-opted, but you are not? If pediatricians are so biased, who says you aren't? In fact, you have more to lose if VT is shown to be worthless, not the Pediatricians. You are more likely to be co-opted, not them, no?
2. Regardless of the imperfection and limitations of scientific studies, it seems every medical discipline in the universe relies on them to try and figure out how best to treat patients. So why doesn't optometry do the same regarding VT for vision-related learning disabilities (besides CI)?
As I re-read your comments about science, I am increasingly dumbstruck that you call yourself a professor. My 9 year old knows that science doesn't answer everything, and that scientific studies are imperfect. I learned in Philosophy 101 that I cannot even prove I exist and am sitting by my computer! So if stents and aspirin are proven to be beneficial, yet stents and aspirin also kill people- so what? Any normal human being wants to know what the odds are, what is true in general- that's what good scientific studies do. Of course they don't prove anything. Did it occur to you that I may be a professor too, and am stunned by your ridiculous line of reasoning? According to your logic, no one should drive a car- after all, cars kill people, no?
I appeal to the regular folk who read this blog-
When you take your father to the doctor with a stroke, you hope to God this doctor has read all the latest scientific studies about stroke, so that he makes the best decision possible. It's that simple. When you take your child to an optometrist with learning disabilities for VT that is unrelated to convergence insufficiency, then this optometrist has no scientific study to rely on. ZERO. You'd be better off taking your child to a tutor or other educational professional.
Thank you for this blog post. The commenter, then, becomes the critic who shapes the writer's next content. So I want to encourage you to keep on blogging in the same style as you writing style is really perfect.
Thank you for this blog post. The commenter, then, becomes the critic who shapes the writer's next content. So I want to encourage you to keep on blogging in the same style as you writing style is really perfect.
Thanks for your information! I’m searching for some information about VT.