Proof & Standards

Crisis, What Crisis?

There is no controversy around vision therapy, but there is nonetheless much comment from professionals and laypeople who are either under or misinformed. This collection of articles is intended to provide a detailed outline of the debates between optometry and ophthalmology with respect to the role of vision in learning. In summary, there is no question that vision is important, as is visual rehab where indicated. Furthermore, we need to check all children for visual impediments before Grade 1, and those impediments need to be addressed as early as possible.

Some people have been led to doubt the role of vision in learning, and the value of vision-based therapies for reading and learning problems. The end result is that child development workers are lulled into believing that if a child struggles in school, vision should not be a concern to investigate. The fact that children suffer through countless hours of testing and therapy without having visual impediments to learning addressed is the real crisis.

Vision is critical in learning, and those who study this area will attest to that fact based on decades of research and clinical observation. Any critical commentary should be considered in the light of the expertise of the one speaking, and of the support offered in the argument. In general, commentary by non-optometrists regarding vision therapy has been steeped in a fundamental misunderstanding about what it actually is.

First some background information. These are excellent pieces explaining some fundamental elements of the role of vision and visual neurorehabilitation in addressing learning concerns.

Flax 1973 The Eye and Learning Disabilities

Birnbaum Role of OD in LD RD 1993


A degree does not make you an expert, only years of research and clinical practice can. Beware of statements from doctors who speak out of their field of specilialization.

This post appeared in some years back.

At first glance to the layman, it appears to be valid and legitimate because there are people with degrees (doctors) who co-authored the piece, and one of them is an optometrist. This is a prime example of ‘experts’ speaking beyond their reach in understanding. As you will see in the articles posted, the discussion is of a much higher calibre and properly supported in research and documentation (in many cases). The Worrall article is reposted here

at the site “Science & Pseudoscience Review in Mental Health”. There is no small irony that there is essentially no support offered in this article for the position taken by the authors. It’s also noteworthy that Dr. Worrall does not work with visual developmental concerns, nor does he have any special training in the area. He’s simply ‘an expert’.

Here’s another example of a non-specialist from another domain adding commentary and appearing to express some expert knowledge in the field of developmental vision science:

Koller Quackery Rev Ophth1998

This sort of commentary is unfortunate, because it can influence what is common knowledge through the media. This is a transcription of an article that appeared in a regional newspaper around the same time:

Article on Physician Position on Vision & Learning

But the facts say something different, and the bias against visual rehab is a dangerous thing. Read this reply from a developmental vision specialist:

Cooper Deflating the Duck

In the following excellent piece, Dr. Merrill Bowen responds to another public statement about the role of vision in learning disabilities. Dr. Bowan does a great job in explaining levels of proof, and how the position paper makes many assertions, but very few are substantiated.

Bowan September 2002

Just Trying to Sell Glasses

Optometrists have long been proponents of comprehensive eye health and vision exams for children entering school because it is the only way of ensuring that they are free of problems that interfere with learning and health. One simply cannot know if the child is not checked, and in general 25% of children in North American classrooms are affected by poor or difficult vision.

Some medical doctors have suggested the move to require eye exams for children is promoted by the ‘eye wear industry’. One could apply this sort of reasoning to anything in medicine where some diagnostic test, medication, or equipment is required and it’s an outrageously irresponsible statement in that it discourages parents from providing necessary care. This would be equivalent to discouraging physical exams for infants and children. The logic goes something like this: If there’s no apparent problem, then why look?

I personally recommend eye exams because as a teacher and doctor I cannot in good conscience stand idly by while children and families suffer needlessly. In most cases, there will be no significant obstacles to learning and health, but in too many cases there will be. I personally have no direct affiliation with any eye wear provider and don’t need industry to tell me about good public health policy. Nor do I mind if people buy their glasses at another provider – so long as they do the right thing for their struggling child.

The following article presents this dangerous position, as well as a fine reply by Dr. Leonard Press, a leading vision development specialist in the U.S.

Press Guest Editorial BV & Strab Sx 2002

Another Public Statement

Following the release in 2009 of another ill-supported and heavily biased statement on learning and vision, Dr. Daniel Lack replied with a comprehensive analysis of the key points asserted in the latest swipe at optometry. It is astounding that so many in medicine reject the possibility that equally intelligent and competent researchers, clinicians, and academics in optometry can know something about vision. It is a a not so lightly veiled suggestion of a conspiracy theory that brings the position statement into question. Optometry has never said that dyslexia does not exist, nor has it been said that bad vision causes dyslexia. It is true, however, that difficult vision will present as reading and learning problems, and in some cases will even mimic ADHD behaviour. When a doctor discourages vision assessment in children, they are discouraging provision of basic human needs and encouraging the use of procedures and medication that may be harmful and unnecessary.

First, the Joint Statement:  Joint Statement—Learning Disabilities, Dyslexia, and Vision

And the reply from Dr. Lack:  Lack 2010 Another Joint Statement

Dr. Leonard Press expands on the discussion, and considers the situation from a broader perspective:

Press 1999 Dichotomy of Vision & Learning Tx

Their Own Worst Enemies

This short article is also valuable in tempering over zealous vision therapists who are prone to make false claims regarding the role of oculomotor dysfunction (OMD) in LD/RD. I personally have correspondence from some who flatly deny dyslexia as a neurological disorder, and this is clearly an unwise position to hold. Indeed, over promising and under-delivering are likely to discourage any acknowledgement of the value of vision rehabilitation, and at times optometrists have been their own worst enemies.

Rosner OMD Not Frequent 1993

The Most Important Recommendations

In the end, the most important recommendations come from those who know best – that is, the professionals who study child health and development. These two statements are very clear in what is best for children as they enter the school years:

AAP Position on Vision 2002

AAO AOA Policy Statement 1997


 Download All Files: Debate Package

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