Behavioral Optometrists Teach Old Eyes New Tricks

CHICAGO TRIBUNE

Aaron Conti's vision problems began two years ago when he smacked his head on the ground while snowboarding on Oregon's Mt. Hood.

When he stood up, his vision was blurred, and the following morning he was seeing double. An ophthalmologist he consulted in Oregon told him he'd better learn to live with it.

A CT scan and MRI ordered by doctors back home showed nothing abnormal, but a neurologist said there might have been some damage at the point of impact and referred him to behavioral optometrist Paul Lederer of Arlington Heights for vision therapy.

Conti, a 33-year-old Illinois computer programmer, was skeptical, , but when his vision worsened, he finally visited Lederer.

After five months of weekly vision-therapy sessions and homework, he learned skills that strengthened the coordination of his eyes so it's easier for him to hold single clear vision.

"It's so close to normal that I never experience double vision in my daily life or while snowboarding," Conti said. "The only place I experience it is if I draw my eyes to a ridiculous extreme that would make most people uncomfortable."

Those like Lederer who practice behavioral/developmental/reha-bilitation optometry deal with training or retraining the eyes to function more effectively, said optometrist Stephen Miller, executive director of the College of Optometrists in Vision Development, based in St. Louis.

The professional organization is 30 years old, yet the specialty is not well known among the general public.

"Everybody who works with athletes understands sports training: hand-eye coordination, depth perception, reaction time, using peripheral awareness," Lederer said. "Well, excuse me, what about these kids who are having vision problems that aren't being diagnosed?

"I even had a problem in school without ever being diagnosed by ophthalmology or optometry. I had a muscle imbalance. I couldn't use my eyes efficiently together. My focusing was poor, and I always got tired when I read. I'd always skip words and lose my place."

Among other patients, Lederer now treats children with those same types of problems so they can improve their academic performance. He was quick to emphasize that vision therapy techniques should not really be thought of as exercises.

Do-it-yourself books containing exercises promising to improve eyesight or even eliminate the need for glasses have been around for years, perhaps tainting the specialized work of behavioral optometrists.

"I'm not one to say it absolutely will not work, but I haven't seen anyone who has successfully eliminated their need for glasses through those programs," said behavioral optometrist Cheryl Sikorski-Meyers of Glen Ellyn. "It's an extremist view."

"We're training the sensory motor system," Lederer said. "We're giving patients an awareness of what their eyes are doing."

Said behavioral optometrist Jeffrey Getzell: "Vision is much more than sight, being able to read an eye chart at a distance of 20 feet. ... "Vision is a process of perception, taking in information, organizing that information and making a response."

For example, consider driving a car. "You're looking out the windshield, you're seeing other cars, people in the road, all kinds of signs, entrances and exits," Getzell said.

"You're seeing where things are located in time and space so you know when to stop and when to go. At the same time, you're sending information to the rest of your body. When you step on the gas pedal or brake, do you look at your feet? When you turn the steering wheel, do you look at your hands?"

"How did the information get there? It's our vision. The whole back of the eye is all brain tissue, and that sends information to the rest of the brain so we know when and where to do something."

Vision and Body Working Together

Getzell calls vision therapy a process of "reorganizing visual skills."

"The key thing is, we're creating mismatches between what you see and what you feel," he said, amid boxes of special glasses, charts and equipment in his Evanston, Ill., office. 'Then you have to reorganize that, and while doing so you become much more aware of how your vision and your body are working together."

This is accomplished, in part, with special training lenses. "We use doubling lenses a lot, which make you see double so you can compare the information coming into each eye," he said. "The more balanced you see, the better your coordination is going to be, the better your thinking is going to be."

Getzell said he has seen many patients turn their lives around as a result of vision therapy.

Morinne Komperda of Morris, Ill., a mother of four boys, is one of them. Her 11-year-old son's problems with reading improved as a result of vision therapy, so she decided to get an evaluation herself.

She said she often would miss exits on highways (especially if she was talking to someone while driving), was involved in two accidents that destroyed the cars, experienced numerous fender-bender incidents and had scary close calls.

An average student, she hated high school and found reading strenuous.

After 10 months of weekly training sessions with Getzell, an empowered Komperda enrolled in Joliet Junior College, where she is working on an associate's degree in nursing.

"My verbal and reading comprehension have improved," she said. "I was shocked when I got my report card. I didn't expect A's."

Similarly, Deanna Kelly of Chicago has seen a marked change in her son Jack's school performance and self-confidence since November, when he began working with Getzell on the recommendation of his school's learning-disabilities specialist.

"We bring him in for sessions twice a week, and then we also work with him at home for 50 minutes a day," Kelly said. "It's a big commitment, but his teacher said she has seen improvements in just about everything he does. His reading comprehension is increasing."

Skeptics Question Ability to Train the Eyes

Despite such testimonials, most ophthalmologists take a dim view of behavioral optometry, according to Dr. Thomas Deutsch, chairman of the department of ophthalmology at Rush University in Chicago. "They're talking about training an organ that can't be trained," he said.

"But there is a huge role for certain kinds of visual rehabilitation that are not behaviorally oriented as much as they are training people to get the most out of what vision they do have. That's called low-vision rehabilitation, which is usually done by a more legitimate side of the optometry world."

Dr. Richard Sarnat, an ophthalmologist who describes himself as an "integrative physician," is more open to the optometrists' ideas.

President of the Alternative Medicine Inc., a company that combines alternative and conventional medicine in HMO settings, Sarnat often "co-manages cases" with optometrists Lederer and Neil Margolis, both of whom he regards as "scientifically minded professional colleagues."

"Those types of cases would usually be people with brain trauma, convergence insufficiency [an eye-coordination disorder that causes eye strain, sleepiness while reading and frequent loss of place while reading], both preoperative and postoperative management of strabismus," a defect in which the eyes point in different directions, Sarnat said.

"I'm extremely conservative about that. I don't do any of more fringe-type referrals beyond those things scientifically documented to benefit [from vision therapy]."

Behavioral optometrists are increasingly treating patients who suffered strokes and traumatic brain injuries.

"There are a number of cases where optometrists and occupational therapists collaborate with patients, and a few cases where they even work together in the same office," noted optometrist Kelly Frantz, a professor at the Illinois College of Optometry.

Margolis, who shares offices with Lederer, frequently works with people who have lost half the vision in each eye or experience double vision after strokes. He also treats patients whose right hemisphere stroke or brain injury results in "visual-spatial neglect."

In the latter, people are unaware they've lost vision on one side and consequently may eat only half the food on their plate or shave only one side of their face.

"My interventions are pretty overt," Margolis said. "If you come here, you understand how I'm going to help you. It's not a hypothetical thing."

For many patients, he said, therapy would be more effective if vision issues had been addressed earlier in their rehabilitation.

What's the barrier?

"Politics," he said. "Insurance. Sometimes people are worried about losing billable hours."

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