On Ignoring the Benefits of Vision Rehabilitation

The Canadian Journal of Optometry printed an article recently that attempted to show how VT has no place in the care of children with learning disabilities. This, of course, is incorrect and potentially harmful, with the possibility that the article would be used to discourage appropriate vision management in this at risk population.

What follows are the original article, a translation, then a reply to the editor of CJO.

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The original Article: http://opto.ca/sites/default/files/resources/documents/cjo_76-2_-_final.pdf

Translation provided by your SysOp: CJO VT LD Article Translation

Dear Editor-in-Chief,

In Volume 6, Issue 2 of the Canadian Journal of Optometry, your editorial refers to the practice of optometry as a diverse profession, managing a wide variety of conditions for our patients, calling upon broad knowledge to understand how to accomplish this. Just a few pages later, one article in particular seems to go far afield professionally in order to justify how optometrists should do just the opposite: Limit diversity in practice, manage a narrower variety of concerns, and forget their extensive knowledge and experience in doing so.

The article in question has already been the focus of much scholastic and professional consternation among those optometrists the article seems designed to marginalize – and with good reason. (See CJO Vol 6, Issue 2, “ Diverses modalities de traitement des troubles d’apprentissage scolaire par therapies visuelles: quelles sont les evidence scientifiques?“) In short, the article is lacking: Lacking in rhetorical strength, in clinical strength and value, and in objectivity; it shows an obvious lack of training and familiarity on the part of the authors in the domain they seek to denigrate. Clearly, this article serves only one purpose, and that is to diminish the perceived value and potency of vision rehabilitation in Canada, written no less by authors who neither practice optometric vision rehabilitation, nor have any training in the field. The reasons for producing such a paper are not immediately apparent from an objective reader’s perspective, but can be inferred from the nature of the writing by those who practice developmental optometry: There is a longstanding push on the part of some professionals to marginalize optometric vision rehabilitation (aka ‘VT’) as ‘unscientific’, presumably in order to ‘protect the public against unscrupulous ‘VTODs’ who make irrational promises regarding children’s vision and then never deliver on the results’. While the same arguments can be made about virtually every profession of healthcare, psychology, and education – and all such arguments would be scurrilous – publishing this particular anti-optometry article in CJO is especially perplexing and concerning. Politics aside, suffice it to say that the CJO is to be cautioned against printing such material in the future should the goal be to maintain any degree of professional impartiality, instructional value, or respect as a truly great journal. One of the obvious responses to such a paper will be that some patients will be discouraged from seeking what is often the only treatment that will help; this in no way furthers the profession, or the betterment of public health – quite the contrary, in fact. So yes, let the experts comment, that is those who actually practice in the field, and let us heed their words.

Given the disparaging nature of the article, it is disappointing the CJO would not insist on including an English translation so that the greater majority of vision rehabilitation optometrists might reply. Academic honesty requires the full light of scrutiny, and there is, in this case, no possibility for scrutiny other than of those who have promoted this paper to publication. This bias is surely unacceptable in a world of double-blinded scientifically evidence-based treatments.

While there are too many errors in the paper to document here, I will remark on a few critical issues. First, the assertion is made that since individual procedures and methods ‘do not cure’ dyslexia, these should be avoided. Indeed, there is no cure for dyslexia, and most of what is now accepted as standard care of children with learning disabilities lacks objective scientific support, including the epidemic use of MRI and medication to adjudicate and manage learning disabilities. Further, orthoptics – a subcomponent of vision rehabilitation training – is commonly supported in ophthalmology, while use of orthoptic principles is equally lacking in ‘evidence-based’ support. Next, the authors assert throughout the paper that visual impediments are an important source of exacerbation in comfort and reading and that these should be addressed when children are suspected of having learning disabilities; currently, there is no requirement in medicine to rule out visual functional concerns prior to engaging in psycho-educational assessments, invasive and expensive medical testing, or use of medication to ‘treat’ these disorders. There is no evidence to suggest this is appropriate protocol, but plenty of evidence to show ignoring visual impediments is unreasonably costly to taxpayers, and certainly more so for the affected children and their families. Finally, the authors recommend following science-based approaches to dealing with learning disabilities, but do not offer any options in this regard.

Vision rehabilitation practices are proven daily around the world in the many clinics that focus on this area, and this is not restricted to optometric clinics. Clinically, and in terms of pure science, there is more than ample support for use of vision rehabilitation in the management of not only learning disabilities, but also for concerns of emotional lability, motor coordination, restoration after brain injury, and performance enhancement such in sport. Those OD’s who actually practice vision rehabilitation know this; those who don’t practice in this area are in no position to comment, quite literally, as is demonstrated by the regrettably insufficient scholarship evidenced in this paper.

What we call ‘evidence’ may be gleaned through observation, rationalization, or both. Those who seek to damage the field of vision rehabilitation are presenting what appears to be a rational argument, but our clinical observations and available research do not bear this out. ‘VT’ works in a variety of contexts for very good reasons, both clinically and scientifically. I would invite all non-rehabilitation practitioners to participate in local and national training events to perhaps develop a broader perspective in just how diverse and potent vision management can be – beyond IOPs, refraction, and pachymetry.

With respect,

Charles A. Boulet, BSc, BEd, OD

Black Diamond, Alberta

References:

  1. http://oepf.org/visual-impediments-to-learning/
  2. http://iris.ca/wp/wp-content/uploads/2012/12/Dr-Quaid-Binocular-vision-research.pdf
  3. “Impact of Simulated Hyperopia on Academic-Related Performance in Children”, S. Narayanasamy, S. J. Vincent, G. P. Sampson, and J. M. Wood; Optometry and Vision Science, Vol92, No 2., 2015
  4. http://learningmanagement.ca/research-by-diagnosis/
  5. http://learningmanagement.ca/proof-standards/
  6. http://drboulet.com/recommended-reading/

 

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