In part 1 of “Opthalmologist vs. Optometrist: Confusion Beyond the Spelling”, we made light of the misspelling of the title of the post – a misspelling that according to our keyword search occurs nearly 1,400 times a month.
The first post also detailed some broad stroke differences between optometrists and ophthalmologists. To further understand how the two professions differ, consider the respective approaches to the treatment of strabismus.
Strabismus is a condition when a patient’s eyes do not work together, which can result in an eye turn. As a developmental optometrist, Dr. Kellye Knueppel thinks that surgery should be a last resort, particularly in cases like strabismus.
“We’ve had much success helping strabismics improve their vision without needing surgery,” she said, a point detailed in a previous post Four Reasons Why You Should NOT Operate First for Strabismus in Children. “We believe that in 80-90% of the cases, we’d prefer the strabismic patient avoid surgery.”
However, there are cases where surgery may be an option. In these cases, Dr. Knueppel feels that vision therapy before and after surgery would improve the functional outcomes. “Unfortunately, collaboration between developmental optometrists and ophthalmologists is extremely rare,” she said.
Dr. Knueppel believes that this is due to poor communication and misunderstanding between the two groups, which stems from differences in training and in how each profession thinks about vision development and visual function.
For example, we recently reported on 3 keys for successful strabismus treatment:
- Getting each eye to function as equally as possible.
- Working on being able to process information through the “strabismic” eye while the other eye is open.
- Emphasizing peripheral visual processing of spatial information.
Typically, ophthalmologists do not address these areas prior to strabismus surgery, other than attempting to get equal visual acuity (clear vision) with glasses or patching.
“If strabismus surgery is being considered, these functional visual skills (and more) should be evaluated and treated, if necessary, prior to surgery,” Dr. Knueppel said. “In addition, once the surgery is performed, a person will benefit from vision therapy.”
Post-surgery vision therapy will help the patient learn to use his or her eyes together rather than just hoping that they will figure out how to do it on their own. Good vision therapy procedures provide feedback for the patient, which helps the patient understand what his or her eyes are doing, and understand how to make changes if the eyes are looking in the wrong place.
Unfortunately, it is extremely rare for ophthalmologists and developmental optometrists to collaborate on surgery cases for strabismus. As result, little or no research has been conducted to support our premise that making vision therapy part of the treatment plan will improve surgery outcomes.
Your takeaway: When treating strabismus, consider vision therapy as a corrective treatment first. If you feel surgery is needed, have your ophthalmologist and developmental optometrist work together if at all possible.
It’s Dr. Knueppel’s hope that some of the disagreements in treatment approaches on conditions such as strabismus can be replaced with more collaboration. “It may be a blow to our collective egos, but the patients will win out in the end.”
(Photo by Plutor)
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