What is Vision Therapy?

Vision Therapy is physical therapy for the eyes and brain.  It is important not to forget the brain's role in vision.  In fact, we actually see with our brains not with our eyes.  For a detailed description, click on the "What is Vision Therapy" link to the left. Or, simply click here:

Are "orthoptics" and Vision Therapy the same thing?

Orthoptics, which means "straightening of the eyes", goes back to the nineteenth century and was limited to eye muscle training and cosmetic straightening of the eyes.  Vision Therapy includes orthoptics but has advanced far beyond the limited scope of orthoptics.  Vision Therapy includes training and rehabilitation for the eye-brain connections involved in vision.  There are many connections between the scientific developments in Vision Therapy and those in neuroscience.

What is the difference between an optometrist and an ophthalmologist?

There are two kinds of eye doctors: optometrists and ophthalmologists.  An optometrist is a doctor of optometry (OD) who diagnoses and treats problems of the visual system.  Some optometrists specialized in vision therapy.  An ophthalmologist is a doctor of medicine (MD) who specializes in surgery and diseases of the eye.

Why do some ophthalmologists and their organizations claim that vision therapy does not work?

Ophthalmologists are not trained in non-surgical treatments for vision disorders

Ophthalmologists are not trained in non-surgical treatments for vision disorders.  Therefore, they naturally are not fully aware of non-surgical treatments such as vision therapy for conditions like strabismus.  This problem was the subject of a worldwide study by Dr. Paul Romano, MD, editor of the journal Eye Muscle Surgery Quarterly.  Dr. Romano asked surgeons around the world whether they were in favour of a surgical or non-surgical treatment of intermittent extropia (a form of strabismus).

In the international group of doctors, 85% were in favour of non-surgical treatments.  However, in the American group, only 52% of doctors were in favour of non-surgical treatments.  Dr. Romano proposed three reasons for why there was this difference:

1. Insurance companies and single-payer systems outside the USA have stricter medical standards in regards to approving payment of eye muscle surgery.  Also, they do not pay as well fro eye muscle surgery as insurance companies in the USA.

2.  Non-surgical therapy isn't as economically rewarding for the surgeon as surgery .

3.  Due to his lack of training in the area, the surgeon is reluctant to acknowledge the benefits of non-surgical treatment for fear of loosing patients.

Vision therapy has been proven effective in treating strabismus but ophthalmologists began to prefer surgery because of the theory of the "critical period"

Dr. Susan Barry published an editorial in 2010 in the Journal of the American Optometric Association where she addressed the history of the treatment of strabismus to illustrate the reason why many ophthalmologists only recommend surgery only to correct problems like strabismus which can be (and have been) effectively treated with vision therapy.  Dr. Barry herself underwent 3 strabismus surgeries as a child which failed to give her stereo vision (since birth she was unable to see in three dimensions).  She saw an optometrist in her 40's who treated her with vision therapy and allowed her to see in 3D for the first time in her life.  The following is an excerpt from Dr. Barry's editorial:

 "Armed with the concept of the critical period, ophthalmologists began to operate on strabismic infants in the first year of life with some success.  With the push for early surgery and an emphasis on treating very young children, they abandoned, for the most part, the orthoptic [eye training exercises] techniques pioneered in the late 1800s by Louis Emile Javal.  These procedures had been effective in straightening the eyes and promoting stereopsis in adult patients, but the time and effort involved in this training was considered prohibitive.  It was left to a small group of optometrists to develop better rehabilitation techniques.

"Frederick Brock and William Ludlam as well as other optometrists spent their careers examining not only how their strabismic patients moved their eyes but what it was that their patients actually saw.  They realized that strabismus is as much an adaptation to underlying binocular imbalances as it is a cause of a poor ability to fuse.  With these observations, they modified and expanded orthoptics into a series of vision training or vision therapy procedures that were enormously effective.  In one study of 149 adult strabismics, Ludlam reported that straight eyes and binocular vision developed in 75% of patients, none of whom had had surgery.  From the 1930's  through the 1950's Brock published extensively in optometric journals.  However, with the growing momentum for the concept of the critical period and the push for early strabismic surgery, these studies were largely ignored.

"Today, a relatively small group of optometrists still practice and continue to perfect optometric vision therapy techniques.  ...  Yet, it is difficult for a strabismic patient to learn about, much less access, this type of clinician.  Many ophthalmologists are hostile to and ignorant of optometric vision therapy and do not recommend, or may actively discourage, their patients from pursuing these treatments.  I was indeed lucky enough to consult an optometrist who saw my need for vision therapy and who referred me to an optometric colleague who was skilled in these techniques.  Finally, optometric vision therapy may not be covered by medical insurance, creating the impression that the therapy is either dubious or unaffordable.  When adult strabismics are told ttha they are too old to change, that those who provide optometric vision therapy are practicing unproven regimes, that the therapy is not covered by insurance, and that their subnormal vision is good enough, it's no wonder a story like mine is "one in a million".  The barriers to better vision for a strabismic patient originate more from old dogma and professional prejudice that from the underlying biological cause"

It is recognized that ophthalmologists are not trained to diagnose visual information processing disorders and that patients should be referred to an optometrist for assessment

Raymond et al. recommend the assessment of visual processing should be done by an optometrist – not an ophthalmologist. The ophthalmologist, according to the authors, does not have the expertise to make the assessment. The study authors note that patients "should be referred to a behavioral or neuro-optometrist. It was also noted that referrals made to an ophthalmologist may be insufficient, as they are primarily concerned with the health of the eye only, and ophthalmologists are mostly experienced with acute medical problems rather than rehabilitation issues. This assertion is supported by considering the typical components of an ophthalmologic exam, which may yield a lack of specificity, and/or provide information which is inadequately defined in terms of rehabilitation consequence. Trobe, Acosta, Kirscher and Trick identify a lack of measurement in areas of distance and near acuities, contrast sensitivity and confrontation, while Gianutsos and Matheson describe a need for greater quantification in terms of field gradations and boundaries, and binocularity conditions. A more thorough investigation is important for the rehabilitative efforts of all patients who demonstrate visual processing deficits.

Are optometrists or ophthalmologists the ultimate authorities on eye care and vision therapy?

The public needs to be aware that ophthalmologists are not the ultimate authorities in all areas of visual health.  Ophthalmologists are excellent surgeons and knowledgeable authorities on eye disease.  However, as a rule, they are not well informed about vision care subjects such as visual processing, convergence insufficiency, accommodation and vision therapy.  In fact, many ophthalmologists agree with this.

For example, in the journal, Transactions of the American Ophthalmological Society, surgeon and researcher Dr. David Guyton wrote that, "[ophthalmologists] have probably abdicated the study of accommodation and convergence to the optometric profession.  A perusal of the literature with reveal that most of the advances in this area are being made in the optometric institutions by vision scientists who use definitions and terms with which we are not even familiar." 

Opthalmologists, while excellent surgeons, are not trained in and do not have expertise in vision therapy and many who criticize vision therapy simply have not done their homework.  Optometrists who specialize in vision therapy are the most credible authorities on vision therapy and developmental vision.

How long has Dr. Randhawa been doing vision therapy?

Seven years.

Will my family doctor be able to talk to me about vision therapy?

Probably not.  Your family doctor spends four years in medical school (following four years of undergraduate education) learning about the body and its systems generally.  Optometrists spend four years in optometry school (following four years of undergraduate education) concentrating on the eyes, vision, and vision disorders.  Therefore,  optometrists are the experts in vision science.  If you have a family optometrist, that doctor will be able to talk to you about vision therapy and we encourage you to speak to your optometrist. 

What is Dr. Randhawa's success rate with vision therapy?

100% of Dr. Randhawa's patients have experienced improved vision, ocular motor skills, and visual processing.  This includes patients with strabismus who have achieved perfect and normal alignment of their eyes along with normal binocular vision through vision therapy.  These patients have avoided surgery and the risks that go along with it.  Dr. Randahwa's success with vision therapy is due to a  number of factors.  Dr. Randhawa does not recommend vision therapy unless there is a very strong likelihood of seeing improvement in the patient.  It is also due to the fact that vision therapy is a very effective treatment for the visual problems and ocular motor disorders for which Dr. Randhawa prescribes it. 

Vision therapy does not work for every condition and every patient and if this is the case Dr. Randhawa will recommend alternative treatments or make a referral to another doctor.

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