Is there a general concensus among the s.m.v. participants on the
meaning of "vision training" (or vision therapy, or visual training/
therapy, or orthoptics, or others)?  I have seen many opinions, both pro
and con (and several quite strong), about the benefits of "VT", but
the term has been used to describe therapy for a wide range of visual
conditions.

For example, I have never prescribed any of Bates' or Huxley's
techniques, and I have never prescribed vision training for axial or
refractive myopia reversal.  However, vision training has long been
an option for me in cases of nearpoint symptoms related to
accommodative or non-strabismus anomalies of binocular vision.  I
make extensive use of VT in cases of strabismus and amblyopia,  
and our BV/Peds Service is currently involved in the development
of vision training strategies for patients suffering from vision-
related learning problems.

When the question (in its various forms) of "Does vision training
work?" arises (as it often does in s.m.v.), strong 'yes' and 'no'
opinions are given, without a clear (IMO) presentation of the nature
of the therapy.  But I am confused as to whether or not the same
concept is being discussed in all cases.  If one were to state that
VT works for myopia reversal, I would tend to side with the naysayers
(except in cases of pseudomyopia secondary to accommodative spasm).
However, if one were to reject vision training in the overall care
of the patient with amblyopia, I would tend to disagree.

There are those who recommend vision training for behavi{*filter*}problems
(including the remediation ofjuvenile delinquents and convicted
prisoners).  Other eye care providers (MANY others, BTW) would reject
this completely.  But, I hope that is not a rejection of vision
training in ALL of it's forms.

I would be particularly interested in the opinions of my skilled
and experienced pediatric ophthalmology colleagues.  It is quite
likely that I am bringing up an old, dead topic or, possibly opening
myself up for slings and arrows.  But, because of my clinical interest
area and my clinical opinions, I wanted to "test the waters".  Thanks,
in advance, for being kind.

--
Bill B. Rainey, O.D.                            |***********************  
Chief, Binocular Vision/Pediatrics Services     |      Bob Knight      *
Indiana University School of Optometry          | really isn't so bad! *
Bloomington, Indiana, USA                       |***********************

Nice to have you aboard, Bill... but yes, this is dredging up a topic that
has been flogged to death around here. The MDs and ODs here on
sci.med.vision have worked this one into the ground and would like very
much to move to other topics. If you'd like to see our discussions, please
look back over the past 800 or so messages. I, for one, don't want to see
this taken from square one again, unless our fine MDs (Granet, Kastl,
Nelson, and others) are just dying to do it.

Just my opinion... Peter? David(s)?

   Walt Mayo, OD
   Myrtle Beach, SC

   HM: 803/650-0140   /  Periscope BBS: 803/650-9022
   WK: 803/546-8421   /  One of OptNet's Best!

SECO '95 - Don't miss the multimedia poster session!!
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: Nice to have you aboard, Bill... but yes, this is dredging up a topic that
: has been flogged to death around here. The MDs and ODs here on
: sci.med.vision have worked this one into the ground and would like very
: much to move to other topics. If you'd like to see our discussions, please
: look back over the past 800 or so messages. I, for one, don't want to see
: this taken from square one again, unless our fine MDs (Granet, Kastl,
: Nelson, and others) are just dying to do it.

Well, for once I find myself in disagreement with sci.med.vision's own
Mr. Nice Guy.  Something definitely got flogged to death around here in
the last few months, but I'm still unconvinced that vision training has
gotten a fair hearing.  It's easy to sling mud at ideas that are outside
of the mainstream, but why can't we have a reasonable discussion here
about areas of vision training that are accepted and practiced by many
card-carrying AOA members?

Dr. Mayo himself made some excellent comments recently about how some
doctors perhaps underestimate the value to their patients of even a
little improvement here or there.  That thread died after comments from
Dr. Granet and myself.  Having been working with a behavi{*filter*}optometrist
now for about three months, I am amazed that I never ran into so many
helpful, simple ideas before this.  In the past, when I complained of eye
strain to optometrists, the most helpful advice I got was "Don't read so
much."  Advice like that I can get for free from the village idiot.  

So I would really like to know what the pros out there think of Dr.
Mayo's original comment (underestimating value of small improvements).  
I can tell you from the patient's perspective that it is nice, for once,
to have found an optometrist who understands the value of such things.

Oh, and whether any of you approve or not, my vision continues to improve
(albeit with a lot of fluxuation).  And I'm still waiting for my
hyperobic shipft to come in!

Patty

--
Patty Kerns                      I'll see it when I believe it.

For your information, Alex... I've never disparaged vision training. I
spent thousands of hours learning and practicing VT. What you've espoused
is no more VT than if someone "palmed" their aching back and considered
that "physical therapy". I am very knowledgeable in vision training having
graduated from one of the leading institutions on the subject in the
world, the Illinois College of Optometry, where I trained under very
respected individuals such as sports vision authority Stephen Beckerman
and Fragile-X authority Dominick Maino.

I am a qualified resource on vision training. Now if what you are
interested in is someone who's on the fringe of the profession... you'll
have to look elsewhere. I am a big believer in VT when it comes to
accepted treatment scenarios and regimens... none of the things you
discuss are accepted by any mainstream VT group, including the Optometric
Extension Program (OEP), or the College of Vision Development (COVD).

We also have some lurkers here who should enter the fray soon, including
Paul Harris, OD, probably the most respected behavi{*filter*}vision authority
in the world today. Paul is the founder and coordinator of the Baltimore
Academy of Behavi{*filter*}Optometry (BABO). He's been a friend and a
tele-"mentor" for years. He wrote me in a recent E-Mail message to let me
know that he felt I had fairly represented behavi{*filter*}optometry's
mainstream during our discussions here.

The doctor to whom I responded to specifically targeted his question to
the other professionals in this forum. It was in that light that I
responded. The VT question has been hashed out here between the doctors
involved to significant degree, both publically and via E-Mail.

The bottom line is you think you know more, have read more, and have more
logic when it comes to these discussions than the pediatric chief of a
major university, several private practioners from two different
countries, and on and on...

It simply ain't so...

Also... in response to your recent "astigmatism-due-to-EOM-stress" thread,
I'd take a look at eyelid tension first... as it's amazing how many
orientals and others with epicanthus and "tight lids" have unusual amounts
of cylinder. It's also interesting how many times I see chalazion-related
shifts in refractive error. Pressure on the globe can cause shifts. I have
not seen EOM-stress cause such.

   Walt Mayo, OD - Behavi{*filter*}Optometrist for over 14 years
   Myrtle Beach, SC

   HM: 803/650-0140   /  Periscope BBS: 803/650-9022
   WK: 803/546-8421   /  One of OptNet's Best!

SECO '95 - Don't miss the multimedia poster session!!
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Howdy, Patty...

Again... please go back and read the doctor from IU's message. He wanted
to start another discussion of VT's benefits _between_ the MDs and ODs...
not the general public. I have not abdicated my role of informing the
public of VT's importance. All I said is the the docs have had enough
exchange _to each other_ here. Again... I advocated NOT starting another
discussion between the docs... not the public. The ODs and MDs here have a
clear understanding of _our_ positions on this subject... and I don't
think most want to continue talking about it to each other. All MDs and
ODs believe in training... what we differ on is the range of conditions
that can be treated with it. We've talked about it enough, me thinks. If
the general public wants to continue talking about it... that's fine.

I have made if very clear that I support the use of VT in many, many
situations. What I do not support is the belief that VT can get rid of
structural myopia. I have said this over and over. Unfortunately, there
are those here who do not differentiate between structural variances and
accommodative/vergence disorders.

Someone like you... who is obviously overcorrected... will benefit from
therapy (IMHO)... someone who has NO accommodative disorder... and is
sitting there with -6.00s on his/her face can do all the therapy in the
world, and nothing will happen to that myopia. That is my firmly held
belief... and it's one that is common amongst most ODs.

I have been very open to communication here and won't stop being so... My
tag line has included voice numbers for my office and my home since I've
started here. I haven't seen anyone else do so. I've offered to pay for
exams so that we can have solid evidence to work with. I hope no one
assumes I've been a hindrance to communication. All I tried to do was
prevent a re-hash of discussions between ODs and MDs that had already been
conducted.

I hope this helps...

   Walt Mayo, OD
   Myrtle Beach, SC

   HM: 803/650-0140   /  Periscope BBS: 803/650-9022
   WK: 803/546-8421   /  One of OptNet's Best!

SECO '95 - Don't miss the multimedia poster session!!
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VT Expert Walt Mayo:

1. Developmental myopia, as shown in study after study, is controllable by
manipulating environmental factors.

2. Even "long-eyeball" myopes have a good part of their myopia due to muscle
spasm.

3. One's ability to accommodate fluctuates according to environmental
factors.

4. Muscle cramps in and around the eyes and neck can lead to an inability
to accommodate properly, and even induce structural changes in the eye by
pulling on the sclera or increasing intraocular pressure.

5. Getting too little sunlight can be bad for the eyes, causing poor
contrast perception and photophobia.

6. Fusion exercises with a yardstick can enhance clarity and depth
perception. So can wearing a patch.

to this I now add

7. Cycloplegia -- routine paralysis of the ciliary body and iris during
eye examinations -- at best relaxes the accommodative mechanism to a point
that the patient cannot achieve without {*filter*}. It rarely produces a
complete relaxation.  In any case, after the drug wears off, the eye
cramps back to "normal".

What has been addressed ad infinitum on this newsgroup is whether or not
anyone can trust my subjective experience. What has not been addressed are
the substantive issues I have raised (especially #1-4 above).

So if a visual training optometrist now wishes to comment on these, or on
ANY issue having to do with visual training, I think we should give him
the full right to do so.

http://www.***.com/ ~aeulenbe/