What is a neuro-optometrist?
Optometrists are eye doctors trained to diagnose and treat eye conditions, emergencies, infections and diseases such as “pink eye” and foreign body removal. Most optometrists are trained and certified to administer drugs to treat these problems when necessary. Many optometrists perform pre- and post- operative care for eye surgeries including cataracts, retinal detachments, laser refractive surgeries and diabetic retinopathy.
Training includes 4 years of undergraduate study and 4 years of graduate study and includes several years in how to prescribe glasses and contacts for clarity of sight, treatment and management of eye disease and neurological disorders, training eye movements (how our eyes work together), vergence (how we point our eyes), accommodation (sustaining and changing our focus), visual perceptual skills (information processing, spatial skills, visualization, memory), and eye-hand coordination (gross and fine motor skills).
Within optometry, there are several different modes of practice. There is general practice, usually called primary care, or specialty practices. Some of these specialties include contact lenses, refractive surgery co-management, dry eye, disease, glaucoma, geriatrics, low vision, neuro-rehabilitative optometry, sports vision, developmental/ behavioral optometry, pediatrics, vision training, and learning disabilities. Optometrists can also choose to go into vision research or teaching.
Primary care optometrists can be thought of as the family or general eye doctor. If surgery or specialty medical care is required, they are referred to the proper specialist. This can sometimes be another type of optometrist and sometimes it can be the ophthalmologist.
There are fellowship programs available to optometrists to become an officially recognized specialist in their field by their colleagues. These programs require that the candidate prove their knowledge by rigorous training, experience in the field, publishing, testing and interviewing by the fellowship committees before fellowship is granted. One such fellowship program is offered by the College of Optometrists in Vision Development (COVD). A COVD fellow is a person that specializes in vision training and binocular vision. Another fellowship program is offered by the American Academy of Optometry (AAO). The AAO has several different specialties that they recognize and each fellowship requirements vary. Some of the subspecialties are Binocular Vision, Perception and Pediatric Optometry, Cornea and Contact Lenses, Disease and Low Vision.
Ophthalmologists are surgeons that spend four years in a graduate program beyond an undergraduate degree, but their program is in medicine or osteopathy. They study systemic disease, including diagnosis, treatment and management. Once they earn their general medical degree (M.D.) or osteopathic degree (D.O.), they also go on to do a four-year residency specializing in the treatment and management of eye diseases including surgery in order to earn the title of ophthalmologist (also D.O.).
Residency includes learning how to manage and treat eye conditions, infections and diseases and also co-manage the systemic problems that can affect the eyes. They also get roughly 6 weeks of training in refraction, depending on the residency, so they can prescribe glasses and contacts if they choose. It is rare for residency programs to teach visual function.
Most of their training is in eye surgery including the following: removal of cataracts, retinal tears, retinal detachment, hemorrhages, tumors, strabismus surgery, plastic reconstructive surgery of the eye and surrounding structures, refractive surgery, and surgical treatment and management of glaucoma diabetic retinopathy and hypertensive retinopathy.
Just like optometrists, they can choose to specialize in any one area such as oculoplastics, neuro-ophthalmology, cornea, retina, glaucoma, pediatrics and strabismus. They can also choose to go into vision research or teaching.
Most of the time, optometrists and ophthalmologists work in conjunction with each other. Some work in the same offices to co-manage patients. At our office, we work very closely with pediatric and neuro-ophthalmologists referring back and forth to one another to best serve our patients’ needs.
How come my child passed the school screening, yet your exam showed that they have significant vision problems?
You can have 20/20 visual acuity in the distance and still have a vision problem that affects performance. School screenings and most pediatric screenings can miss up to 51% of vision problems that can affect academic performance simply because they will only screen for distance visual acuity and sometimes health. How clear you see and how healthy your eyes are have a very small part in how the eyes and brain function together. Vision screenings should also include at the very least depth perception, eye teaming, focusing, eye movement control and form perception.
What is the difference between a school vision screening and a visit with the eye doctor?
A vision screening only determines if you are at risk of having a potential problem. A full examination will confirm or rule out a vision problem through extensive testing. It is like getting your blood pressure checked at a station in a drug store. It can flag you that you may have a problem, but a health examination and blood work will determine whether or not you truly have heart disease or hypertension. Diagnosing a health problem, including a visual problem, requires several tests and analysis by your health care practitioner.
How will I know if my child is having any vision difficulty?
Many children who have problems adjusting to school demands may have underlying, undetected vision problems. The best way to know is have your child examined.
When should my child’s eyes be examined?
According to the American Optometric Association (AOA), infants should have their first comprehensive eye exam at 6 months of age. If there are no risk factors or interventions, children then should receive additional eye exams at 3 years of age, and just before they enter kindergarten or the first grade at about age 5 or 6.
For school-aged children, the AOA recommends an eye exam every two years if no vision correction or intervention is required. Children who need eyeglasses or contact lenses should be examined annually or according to their eye doctor’s recommendations.
Early eye exams also are important because children need the following basic visual skills for learning:
- Near vision
- Distance vision
- Eye teaming (binocularity) skills
- Eye movement skills
- Focusing skills
- Peripheral awareness
- Eye/hand coordination
Because of the importance of good vision for learning, some states, like Kentucky, require an eye exam for all children entering school for the first time.
What is Neuro-Visual Therapy?
Vision Therapy is individually prescribed treatment programs prescribed and monitored by the doctor to remediate visual delays or inefficiencies. Exercises and techniques are designed to support, integrate and enhance visual input and processing skills, eye-hand coordination, movement, balance, attention, learning and cognitive skills.
It is prescribed after results from a comprehensive eye examination and most often a further visual analysis indicates that vision therapy is an appropriate treatment option. The vision therapy program is based on the results of standardized tests, the needs of the patient, and the patient’s signs and symptoms. The use of lenses, prisms, filters, occluders, specialized instruments, and computer programs is an integral part of vision therapy. Vision therapy is administered in the office under the guidance of the doctor. It requires a number of office visits and depending on the severity of the diagnosed conditions, the length of the program typically ranges from several weeks to several months. Activities paralleling in-office techniques are typically taught to the patient to be practiced at home to reinforce the developing visual skills.
Research has demonstrated vision therapy can be an effective treatment option. Some examples of vision problems remediated in vision therapy:
Ocular motility dysfunctions (eye movement disorders)
Non-strabismic binocular disorders (inefficient eye teaming)
Strabismus (misalignment of the eyes)
Amblyopia (poorly developed vision)
Accommodative disorders (focusing problems)
Visual information processing disorders, including visual-motor integration and integration with other sensory modalities
Do you work with individuals with Autism Spectrum Disorder, Dyslexia, ADD, ADHD and Developmental Delay?
Yes! If there are any delays in development or sensory-m otor integration issues, most often vision is also affected and can be remediated. If there are any attentional, reading or learning issues, vision problems should be ruled out. Many signs and symptoms of ADD or Dyslexia mirror the signs and symptoms of a vision problem.
Is a comprehensive exam needed for contact lenses?
Yes, before being fit with contact lenses, a comprehensive eye exam must be performed. In the exam, your eye doctor determines your prescription for corrective lenses and checks for any eye health problems or other issues that may interfere with successful contact lens wear.
If all looks good during your eye exam, the next step is a contact lens consultation and fitting. The fee for contact lens services varies depending on the type of contact that is needed. If you already wear contact lenses and know the type of contacts you were, i.e. spherical, toric, monovision, soft, rigid, etc. our staff can better quote a service fee for the visit.
All subsequent follow up visits are included in the initial contact lens fee.