The Death of the VTOD
Merrill Bowan: Born 9/9/1942. Passed away Saturday, October 14, 2017 at Age 75, of Oakmont, PA. Merrill graduated with a BS from Geneva College then later graduated from Illinois College of Optometry. He was a leader in the field of behavioral optometry and had a private practice for over 40 years in the Oakmont area. I’m glad to provide a few links below so you can learn more about Merrill’s work. I was a fan, especially of his ideas around pediatric vision and motor skills development. For background, an optometrist carries the designation OD, whilst an optometrist who works in the area of Vision Therapy & Rehabilitation, is often reffered to as a VTOD.
Merrill was a sparring partner on a VTOD mail list for a number of years. He and I held what were considered opposing, or controversial views to what the general consensus held. And we disagreed with one another on many occasions. Merrill, for example, held that minuscule amounts of yoked prism compensation, what he called microprism, held promise in releasing some visual strain related to reading and other concerns. For myself, I rejected the popular notions on the group that dyslexia was entirely visually based and therefore correctable through appropriate vision therapies. Elsewhere, I resisted arguments that compelled parents to mortgage their homes in the hopes that expensive weekly vision therapy would solve their children’s learning, behavioral, and future professional problems. Nowadays, the microprism (yoked prism correction less than 1.0D) is in common use in therapeutic ophthalmic lenses. And, as a rule, people accept that while vision dysfunction and dyslexia can be related, and indeed some visual dysfuction is routinely misdiagnosed as dyslexia, they are not the same beast. To my understanding, it is not common practice to advise mortgaging homes to attend Vision Therapy.
Initially, Merrill and I agreed on few issues, but these were generally mundane, canonical in nature: Hyperopia/farsightedness is toxic to learning; there is an environmental element to myopic progression. We also agreed that brotherhood, respect and collegiatlity, and the pursuit of truth were inextricably entwined with our professional practice. While we disagreed, we never turned to insults or belittling, bullying tones. In time, on and offline, our paths became more aligned, parallel almost. His work on visual motor and perceptual training, based on the work of Jerome Rosner, became the foundation for my first foray into therapeutic software, ‘GeoBee’, which was a captivating tool that presented Rosner Dot patterns with feedback to assist with motor control and memory building. We’d spoken a few times by phone, made some wonderful connections in science and in faith. Merrill was a model VTOD for me: Intelligent, inquisitive, hard working in his own research, and stalwart in his forward movement, despite the acrimony and resistance he experienced. Then he died. Every year since I remind myself to post about him.
This year, this celebration is coincident with what I would call a great uproar on the latest iteration of the VTOD mail list, the VTODs on FaceBook group. This was/is in relation to a wonderful training program for Occupational Therapists (OT’s) developed through PESI.com. The program details can be found here: https://www.pesi.com/search?keyword=boulet&keywordSearchType=All
This certification program is comprised of direct instruction on the fundamentals of human visual function, as well as an introduction to some concepts in therapy – rehabilitation of visual dysfunction resulting from developmental trouble or brain injury. Students earn 35.75 CE Hours with the Adult Vision Package or 32.75 CE Hours with the Pediatric Vision program. My own background includes a degree in neural science/neuropsychology, another in education/instructional design, and a doctorate in developmental optometry. The other authors are likewise well-versed in their own domains with dozens of years of experience between them. As a team, we cover a lot of ground in little time. This information is in high demand, and needs to trickle out to those who need the background but cannot otherwise gain access to it. The mode of delivery and price means that many more therapists will have their eyes opened to the world of vision, vision rehabilitation, and learn where to go for help. Importantly, the program directs participants to pursue further education with organizations like OEPF, COVD, and NORA, names not top of mind with most OTs.
One of my personal goals in assisting in this production was to elevate the discussion around vision vis-à-vis Occupational Therapists, whom, through their training, understand that vision is likely important in therapy, but do not have the background to move them forward in studies. The PESI.com platform is well-known and respected and the source of professional Continuing Education (CE) credits for those whom for myriad reasons prefer remote learning and instruction. The launch of this basic certificate program will be available to millions online, and through direct marketing to hundreds of thousands of therapists in the US. Typically, while some mainstream VTOD training events are held sporadically here and there around the US and Canada, mostly these are inaccessible to OT’s and other therapists due to location, cost, relative benefit/topic, restrictive advertising, and sparse availability.
The announcement of this program on the one hand has been warmly welcomed by the broader therapy community – they are happy to have access to professional content to help fill in the gaps. In the VTODs on FaceBook group, not so much – many of the VTOD’s see this as encroachment, that somehow education is a negative, that we should not be teaching OT’s what we know. Worse, the detractors’ statements reveal a hubristic bias regarding the allied therapeutic fields – namely that OT’s are not doctors of optometry and therefore do not have a background sufficient to tackle broader motor and perceptual processing of vision, nor are they worthy of even learning more. The impression is that the VTOD community, which generally offers little to nothing to OT’s in the way of accessible formal education, is at risk of others learn about vision and visual dysfunction. At the same time, all optometrists are routinely exposed to information via ophthalmology and occasionally neurology, and yet there are no concerns about OD’s encroaching on those domains.
This is not new. VTOD’s, like all optometrists, take their view of the world standing on the shoulders of giants; in other words, OD’s, like yours truly, do not own the data or the knowledge, we simply borrow it to pay the bills, hopefully add to the canon during our clinical lives. This idea of borrowed wisdom is a cornerstone of all professional training programs. Likewise, optometrists are exposed to many ideas and procedures during their lives that they will never actually use or perform themselves (such as surgical procedures and techniques). Still, the exposure to such concepts informs the broader discussion between providers and this facilitates and improves patient care.
It’s a mystery why any professional group would adhere to a gatekeeping approach to professional development, maintaning restrictive access while decrying those who try to build bridges. Given the ratio of OT’s to OD’s in North America, it’s even foolhardy – OT’s are a primary and key point of contact when it comes to pediatrics and brain injury, for example. In the instance in question, the critiques emanated from open mouths, but closed eyes – acrimony but none of the commentators were actually even conversant with the curriculum, the goals of the program, or had taken a moment to speak with the instructors. As a doctor, I question any other doctor or professional organization that a) does no research, b) speaks without asking questions, and c) maintains such a heavy double-standard.
There’s a lot to learn from within the VTOD community, but equally as much from the outside. The lack of inquiry, the brutal bullying of contrary points of view, occasional blind adherence to ill-defined clinical standards (yes, Syntonics, I’m talking about you), and the self-isolation as the gatekeepers of vision-related care, all these will surely lead to the death of the VTOD as an open source of reliable information, an interested partner in making therapy accessible. Closed doors and isolationism are first implemented with restrictive access to knowledge and wisdom. With Merrill, there was balance and a willingness to engage bravely, sometimes discarding old ideas – even in the face of rank professional bullying and ridicule. To the day he died, he understood the pursuit of accessible and appropriate vision care was of primary importance.