my optometrist's opinions vs. my vision therapist's opinions
I had my 12-week evaluation this week. Indeed, things are progressing nicely, and my amblyopic left eye has improved. It was 20/30 with glasses when I started therapy, and now it's 20/20 + or -.
I saw a few stereo images with the polarized glasses (at a vision therapy session on week 6 we were doing a heap of 3D exercises to 'play around' with 3D, and I saw quite a lot more compared with this 12 week evaluation.) I wasn't worried by this, because that 6-week appointment my binocular brain was obviously very activated, whereas at this evaluation we were starting with a cold engine, if you will.
I demonstrated difficulty using my eyes together, and the worth 4-dot was together at distance, and then it split, and there were some troubles with it at near, and my optometrist talked about the vertical component to my strabismus.
I then asked her about my prospects, and was disappointed when she suggested that by the end of my therapy I would probably have peripheral fusion and some fusion at very close (like, in front of my face.) I hope to achieve steering-wheel popping fusion!
Then I saw my vision therapist, and as the Dr gave her exam results, my therapist reminded her that I had seen real 'float' at that 6-week appointment (with yoked prism glasses on), and my therapist reminded the Dr how important it is for me to slowly, deliberately build my skills (we are still doing a lot of patched exercises.) I think my therapist was trying to gently nudge my Dr by reminding her of this.
I got the sense that my Dr thinks one thing, and my therapist thinks something else...so I asked my therapist her opinions after the Dr left.
During the rest of the therapy session, it seemed like my therapist was respecting 'office politics' in her non-Dr position but also promoted her own opinion, as a therapist who has been working at this for 13+ years, she thinks I'll get where I want to be. My therapist has been working with me for 18+ hours now, whereas I've been with my Dr for probably 45 minutes total.
I trust my Dr because she's been to school and knows all the techniques and lenses, but I also highly value my therapist's opinion, because she is the person who works with strabbies day in and day out. My therapist also thinks the Dr is conservative, so perhaps that's a factor here as well.
I'm wondering if this 'difference of opinion' is something others have experienced? Can a vision therapist know more than, or something different than, the Dr she is working with? What role do you think a therapist's education and experiences have with predicting outcomes?
and I'd love to hear my fellow strabbies' opinions/experiences with their docs 'n' vision therapists.
Views: 49
Replies to This Discussion
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Permalink Reply by Josh Behan on -
One of them has an advanced doctoral degree in the workings of eyeballs... But the other does the legwork for 40 hours a week, and spends time with the actual patients. I did the math and it seems you've spent 4% of your in office VT time with the doc, and 96% with your vision therapist. Interesting, no?
One way to look at it is this. Sometimes a teacher will offer a student a challenge to get them to work hard and prove the teacher "wrong." For instance, I might say to my students, "This grammar point is really difficult. I'll try to teach it to you, but you probably won't understand. It's just too hard for students like you." Then the students will take up the challenge and work hard to prove me wrong. They'll accomplish something and feel good about themselves.
Perhaps your optometrist is offering you a challenge. Or perhaps she's just Debbie Downer. In either case, take the challenge!
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Permalink Reply by Lynda Rimke on -
Since my VT and my Dr. are the same person, who elected to take me on herself, I cannot vouch for the differences in opinion! ... but I can offer my perspective: Drs. have to remain conservative in their optimism, and stick with what they see for themselves. If she doesn't see proven fusion, I can talk about it all day and she won't be convinced. I appreciate her bedrock opinion that is beyond debate.
I think of her as that keel that is needed and balance my overblown sails. One cannot sail without both!
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Permalink Reply by Sue Barry on -
Dear Sally,
First you need to step back and realize how far you've come in 12 weeks.
Second, seeing the steering wheel pop out resulted from peripheral fusion. When sitting in the driver's seat and looking at the steering wheel, I was looking at a big, circular target that took up a lot of my visual field. It's peripheral stereo that also gives one the sense of layers and layers of depth. Fine stereo allows one to see random dot stereograms. You may have misunderstood your optometrist's expectations.
But there's something more. I've been with my optometrist for 8 years now. I think the world of her, and we have a very comfortable relationship. When I was doing VT in her office with her therapists, I felt very comfortable after the first few visits, and I was at my best. This is simply not true during my 6 month vision exams. I just had an exam, and even after all this time, I get very nervous. The exam brings back a lot of bad childhood memories even though these memories have nothing to do with my optometrist today. I don't care who it is, when someone brings up their hand or occluder, to do the cover test, I just want to punch them in the nose and walk away. In short, I'm a bit of an emotional mess when I go for my exams, and I never do as well as I do at other times.
So don't be discouraged. You're doing wonderfully. VT is a journey and no one can tell you where it will end. Keep a journal and savor each new visual experience. The best part about VT is that so much of it is up to you. You are rehabilitating your own vision.
Best,
Sue
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Permalink Reply by Robert (Bob) Hohendorf OD on -
Hi Sally,
Stay positive. Remember: "if you think you can or you think you can't you are probably right".
I have noticed that if I spend 3 hours testing a patient I can find something new about that patients vision after 15 minutes in the therapy room. Although both your doctor and your therapist are each looking at the same visual process (yours), they are viewing it from slightly different perspectives.
Bob H
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Permalink Reply by Sally Rye on -
Wow, everyone, thank you for taking the time to share your insights.
Josh, I like your idea about accepting the "challenge!"
Lynda, thanks for your apt observation: Drs have to talk about the observable, measurable, record-able.
Sue, I did not understand "peripheral fusion" at all--thank you for clarifying that! I absolutely misunderstood her, and thought I was limited to expecting some sort of fusion way out on my periphery.
And you raise another excellent point: the "white coat hypertension" that happens in The Exam Chair. I am going to raise my hand as someone who also has PTSD when the occulder starts bopping in front of my eyes...the jaw clenches a bit, I get tense & resentful. I didn't think I was reacting *this* time, at this visit with my happy-nice developmental optometrist...but as you suggest, there's a visceral response happening. (I get tense as heck at the dentist, too, and my dentist is great.) Furthermore I was so worried about my performance...would my eyes look good? can I show her that I am improving? etc.
Bob, I appreciate your insights as an optometrist. that is remarkable, that you can find differences in patients' vision when examined after 15 minutes in therapy...and it makes total sense.
Thank you all for the encouragement...I guess I also didn't realize that I was needing a little "hey, you're doing great"-type of feedback, which now when I re-read my original post, there is a lot of "am I doing ok?" written between the lines, isn't there?
And thank you Lynda for inviting me to this forum! I'm so grateful to have had this opportunity to wonder outloud with my fellow strabbies. :)
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Permalink Reply by Lynda Rimke on
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It is wonderful to "wonder out loud" isn't it?
I'm enjoying my sovoto forays even more than facebook visits. Having all the comments and conversations come to my email IN box has been such a great tool to keep me psychologically "in the game." I've got to say I'm as encouraged and pumped by this forum as you!
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Permalink Reply by Susan Hall on -
I had to chuckle when I read about sovoto vs facebook--I totally agree!
Thank you, too Sue for your defintion of peripheral fusion, I also thought it was "fusion in the periphery" I don't know if you an answer this or if an optometrist needs to chime in, but if I can see a "bump" on the red/blue randot, but only occasionally see a glimpse of a circle--is this fine or peripheral fusion? My optometrist says I may be seeing monocular clues, but am not sure how that can be when they're at 30 (prism?diopter?). -
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Permalink Reply by Dan Press on -
Hi Sue,
One way to check if you're using monocular cues is to close one eye. If you still see the bump then it is a monocular cue if it is different than when both eyes are open, then you are developing central stereopsis. Peripheral fusion is referring to relatively larger objects that you can fuse but don't require the two maculae (central part of vision) to be exactly lined up. Central fusion, as tested by randot forms, require the maculae to lined up exactly. There is a continuum of central stereopsis and it is not an all or nothing event as some people think. Patients describe it as seeing "something" without being able to identify it and that is the first sign that fine stereo is being developed.
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Permalink Reply by Susan Hall on
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Yes, I really appreciate your detailed description Dr Press....I still like your allusion to "turbulence"!
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