Several years ago, I realized that less is more and scrapped the page-long mission statement for my practice, replacing it with this: “The mission of Bright Eyes Family Vision Care is to empower our patients with the best in friendly, professional, and individualized eyecare.” It was a huge improvement. But today I feel I could reduce what we do even further, to just one word: empowerment.
To empower is to “make someone stronger and more confident, especially in controlling their life and claiming their rights.” As an optometrist, that is what I do. My main motivation is not so much to provide services and products to patients; rather, I am passionate about empowering my patients to overcome obstacles that are keeping them from being as successful and effective as they can be. For some patients this means driving safely in rainy Florida nights. For others it means being able to complete a full day of office-work without headaches. For some of my younger patients it means transforming reading from an uncomfortable chore into a joyful pastime.
While we have many methods of helping patients, such as specialized glasses, contacts, and orthokeratology, the most powerful empowerment tool we have is vision therapy. The reason for this is simple: it is a system of improving visual self-awareness, confidence, and skill. Vision is much more than just clarity of sight (i.e. 20/20). It is the primary way that people interact with the world around them. It is how they gather information about the space they are in, the people they are with, and the options that are available to them. Vision guides our choices and behavior. There is a famous saying in optometry by Dr. John Streff: “When vision is working well, it guides and leads; when it does not, it interferes.” Vision therapy helps vision lead – not interfere.
Many aspects of a vision therapy program naturally flow from the goal of patient empowerment. One issue that is discussed very early on, in fact before the program even starts, is motivation. Patients are more successful if they have a clear goal. No matter what their age, they are going to gain more from vision therapy if they are intrinsically motivated to succeed at some element of their life, be it sports, school, or video games. A reliable system of reminders is important, but if patients are primarily in it for bribes or are being coerced, they will not be as successful. An unmotivated patient may complete the activity checklist but not assimilate the information for future use. This limits the skill’s transferability and may ultimately lead to regression.
Another area of emphasis is therapy ownership. We want patients to feel that their problem is a visual one and that they are gaining the knowledge and skills to overcome it. Vision therapy is not something that patients have done to them. Doctors and therapists and parents are simply providing resources to help them help themselves. The patients are doing the work and should rightly feel that they get the credit for success.
This is why home vision therapy is so critical in reinforcing office-based therapy. After the education, discussion, and prompting that occurs in the office, patients have time to practice these skills in their own home. If we have done our job correctly, they will use the tools, information, and reminders to do the activities and then make discoveries on their own about how their vision works and what leads to success. For example, they may notice physiologic diplopia on their own before using a Brock String.
Additionally, vision therapy at home gives them the freedom to practice within their busy, modern schedule. Because practice is very, very important in learning any new skill, helping patients keep to a prescribed schedule is critical. Research has shown that 5 to 10 practice sessions of short duration (~10 minutes) spaced 1 to 3 days apart often lead to performance gains that are retained for months and years. While this is logistically difficult to accomplish in the office, it can easily be accomplished at home as long as there is a reliable system of patient education and communication. That is the main feature of the app we use in the office, Binovi App from Eyecarrot, that appeals to me.
As a father of two young children, Nora and Javier, I have realized that vision therapy is like parenting. In both cases, my goal is to help them make choices so that they can succeed and thrive independent of me. I want to give patients the skills not just to complete their daily tasks efficiently, but to understand how their vision works so that they can adapt to the future challenges of life.
And that is empowering.
Vision Leads Foundation homepage.
Karni, Avi, “Adult Cortical Plasticity and Reorganization,” Science & Medicine, January-February 1997, PP 24-33. https://www.sciandmed.com/sm/journalviewer.aspx?issue=1058&article=715