As you delve into the world of vision therapy, sometimes referred to as vision rehabilitation or orthoptics, keep in mind it is a therapy program to address deficits of the visual system. It stands to reason that if it involves the visual system, it is important to seek out a program that is overseen and monitored by an eye doctor. It is advisable to be under the care of a Residency Trained Neuro-Optometrist. If you have access to an eye doctor with this level of advanced training in your area, or within driving distance, this should be your first choice.
Remember most eye doctors have not been trained to diagnose binocular vision deficits or binocular vision problems associated with acquired brain injury or neuro-degenerative conditions; so often times, the discussion of binocular vision symptoms doesn't even come up during the exam. This is why individuals can experience symptoms that can take several years for general care eye doctors to diagnose. General care eye doctors direct their attention to testing visual acuity and prescribing glasses or contact lenses. Glasses and contact lenses correct eyesight deficits (reduced visual acuity), while vision therapy corrects binocular vision dysfunction. That's why someone can have 20/20 vision yet experience symptoms of binocular vision dysfunction – glasses and contact lenses do not correct binocular vision dysfunction.
Visual acuity, clarity of eyesight, is very different from visual function. Visual function is how efficiently the eyes (receptors of images) transmit those images to the brain, and how effectively the brain processes those images and gives meaning to what we see. Visual function involves binocular vision skills, visual processing, visual processing speed and working memory.
It is important to note that vision therapy is not a series of eye exercises to make the muscles of the eyes stronger. The muscles surrounding the eyes are some of the strongest muscles in the body. Vision therapy does involve the neurological component (eyes and brain working together) of vision; which is why it is so important to seek the care of a Residency Trained Neuro-Optometrist. The term neuro-optometrist is used to identify optometrists who have completed the rigorous application and acceptance process, been accepted into and completed a residency program in the sub-specialty area of neuro-optometry. Residency trained neuro-optometrists assess the function of the overall visual system, evaluate binocular vision function and visual processing, and provide research-based assessments and evidence based vision therapy treatment programs.
Not everyone is aware of the differences in training among vision therapy providers. Let's explore some of the different types of vision therapy programs available in the marketplace, and what to look for in a treatment program. The first step is to evaluate the training and credentials of the individual overseeing the vision therapy program. This can be easier said than done. There are some eye doctors, who do not have any advanced clinical training in vision therapy yet offer this service. The majority of eye doctors receive training in the area of vision therapy during several hours of continuing education at annual optometry conferences. This method of education lacks any formal academically based clinical training. The same can be said for occupational therapists. Occupational therapists do not complete advanced clinical training in the field of vision therapy, and most do not perform vision therapy under the direction of an eye doctor. Occupational therapists typically receive vision therapy training in the form of weekend seminars, again education without formally structured, academically based clinical training. To add further confusion, there are national franchises that advertise vision therapy services, but most do not employ licensed healthcare professionals with any training specific to vision therapy.
A good first step is to rule out vision therapy programs that are not under the direction of, overseen by, or regularly monitored by an eye doctor. Remember, this is the visual system we are talking about. An eye doctor should monitor the results and progression of the vision therapy program.
Let's take a look at the types of eye doctors who diagnose binocular vision dysfunction and provide vision therapy.
The term neuro-optometrist is used to identify optometrists who, after graduation from optometry school, elect to complete formal academic residency training in neuro-optometry, binocular vision and vision therapy. Neuro-optometrists provide research based assessments and evidence based vision therapy treatment programs. Keep in mind, most optometrists do not have residency training. Residency training for optometrists is optional, advanced training within a specific area of sub-specialty. Neuro-optometry is a sub-specialty field of vision care that combines neurology and optometry.
The term behavioral optometrist is used to describe an optometrist who has not completed formal advanced training, such as residency, but elects to provide treatment separate from mainstream optometry. The term behavioral optometrist is an umbrella term which also includes developmental and functional optometry. Behavioral optometrists attempt to improve vision and well-being using eye exercises in ways that depart from conventional optometry.
The term developmental optometrist is used to describe an optometrist who has not completed formal advanced training, such as residency, but elects to provide treatment separate from mainstream optometry. Developmental optometry is a health care profession that is considered to be more “self contained” and separate from mainstream medical science. Similar to behavioral optometrists, developmental optometrists do not adhere to research-based testing and treatment protocols. Instead developmental optometrists typically elect to pursue less conventional, unproven treatment.
If you are considering vision therapy, the first step in the process is an in-depth binocular vision assessment. When you call to schedule an appointment be sure to ask:
If the answers to the above questions are yes, you can feel confident that you have found an eye doctor who is trained and qualified to provide research based assessments and evidence based vision therapy treatment programs.
Dr. Ryan C. Johnson in Boise, Idaho is a residency trained neuro-optometrist. Dr. Johnson's residency at University of California Berkeley included neuro-optometry, binocular vision and vision therapy. If you have questions about binocular vision assessments or vision therapy, please give our office a call at 208.377.8899.