Finding Your Passion For All Things Vision in Occupational Therapy

My interest in all things “vision” in the occupational therapy world has been stewing for several years.

Working as an occupational therapist in inpatient rehab, I became interested in perceptual skills but did not dive into furthering my education or competency because I was more concerned with continuing education courses designed for stroke recovery, neuro-shoulder rehab, etc.

Then I Switched Settings…

A move to working in an outpatient neuro setting sparked my interest further, but in an effort to keep my treatments as “functional” as possible, I kept to the more traditional strengthening, coordination, balance, self-care arena.

I did happen to work with an OT who occasionally completed low-vision assessments, and I learned so much from her regarding where to seek promising courses. At the time, I had some difficulty locating courses that were more specific to adult-rehab.

I found a web course and though it was focused on vision related to children/ASD, it gave me the foundation I needed to comfortably expand my treatment repertoire. (An interesting fact I learned in that course – which is probably not news to you peds OTs – is that potentially 50% of kiddos with ASD have a binocular vision disorder.)

Two kiddos and one relocation later I made it my mission to carve a niche for myself at a new clinic and expand their vision offerings.

Expanding My Knowledge

With a driving program on-site, many of my patients had end-goals of returning to driving, especially if a physician was recommending they complete a driving evaluation. I realized in my previous concern for maintaining a function frame of mind that I had neglected to consider return to driving as necessary independence (now whether driving was a even a realistic goal for past patients I cannot recall).

I was now seeing a smattering of patients that were either self-aware of their potential roadblocks to driving or had family members who were concerned.

I suppose as I have become more confident in assessment I can more easily recognize visual dysfunction, which may account for the increased number of patients I have seen over the last several years with visual impairments following a neurological event.

Whether for this reason or another, advancing my vision competency became just as much necessity as interest. Though I work with patients in an outpatient setting, the foundation for tackling visual issues and educating your patients begins in the hospital.

Inpatient rehab especially can be a great opportunity for assessment and sharing of objective data to determine a person’s improvement post-event. I hope to share with you how you can develop your vision skills and establish a “program” of sorts to guide your care and excite your interest.

First Step: Educate Yourself!

The best vision course I have taken, hands down, was Understanding and Managing Vision Deficits: A Guide for Occupational Therapists by Vision Education Seminars. Dr. Mitchell Scheiman is an optometrist who is married to an Occupational Therapist. His courses are focused toward OT’s specifically, and I cannot express how much I learned from him.

He and his wife have also written two textbooks: Low Vision Rehabilitation: A Practical Guide for Occupational Therapists and Understanding and Managing Visual Deficits: A Guide for Occupational Therapists.

These are great reference guides as you are learning as well. You can find more information on his website at Vision Ed Seminars. At this time, his course offerings appear slim, but I would keep checking his site or consider purchase of a textbook.

I have seen an increasing number of vision-related courses in recent years. I would suggest searching for courses focusing on adults or even brain injury (that is, if you are an adult-based therapist) as assessment and goals will be different between the two age groups (for example, adults may have goals of returning to driving).

Key Players in the Vision World: Developmental Optometrists

Six months after attending Dr. Scheiman’s course I decided to begin reaching out to area vision specialists to learn their practice as well as make some connections. I decided to contact a developmental optometrist and a neuro-ophthalmologist to shadow for a few hours. After a few emails, I finally had appointments to learn about these fascinating professionals!

You are already familiar with the vision-responsibilities of PT’s, OT’s, and SLP’s, and most likely have an understanding of neuro-psych testing. Developmental (or behavioral) optometrists, however, may not be on your radar—but they should be!

You can find a list of developmental optometrists in your area at COVD-Locate a Doctor. A developmental optometrist takes basic optometry a step further and evaluates and treats more complex issues such as binocular vision, peripheral processing, visual midline shift, and alignment issues, BUT to my knowledge they do not complete formal visual information processing assessments (ding ding ding, score one for the OT’s!).

They may use prism to improve diplopia and generally have a team of vision therapists to treat patients. Cost does vary—sometimes out of pocket for the patient, sometimes covered. I recommend inquiring to the optometrists in your area.

After completing my observations, I came to see developmental optometry as a fairly holistic approach that aligns well with the OT frame of mind. Other professionals may not agree, but I tend to see them as similar to a chiropractor when compared to an MD neuro-ophthalmologist.

If you are fortunate and establish a relationship with an area developmental optometrist, you may consider asking if they would provide a short class for your facility. The optometrist I contacted was happy to oblige and the class was very well-received at my facility.

If you’re interested, you can find more information about visual midline shift, peripheral processing, and post-trauma vision syndrome at Padula Institute of Vision Rehabilitation.

A great book for therapists and patients alike is, “The Ghost In My Brain: How a Concussion Stole My Life and How The New Science of Brain Plasticity Helped Me Get It Back”, By Clark Elliott.

Neuro-ophthalmologists

Neuro-ophthalmologists may be more difficult to locate, but most likely you will find them connected to a university medical center. These MD’s are treating diagnoses such as field deficits, cataracts, idiopathic intracranial hypertension, occluded vision, nystagmus, optic neuritis, oscillopsia, strabismus/phorias/alignment issues, and nerve palsy’s.

They complete extremely thorough (and long) examinations and treat in accordance with traditional medical practice—medications, surgery, prisms, etc. They may want a patient to wait for an appointment to see if symptoms related to nerve palsy’s spontaneously resolve (but check with your area MD for their specifics!). With persistent and functionally disrupting diplopia, oscillopsia, or nystagmus, your patients may benefit from a referral sooner rather than later.

To my understanding, traditionally neuro-ophthalmologists do not believe that exercise provided by a developmental optometrist will improve symptoms related to strabismus, palsy, binocular issues, etc. This creates somewhat of a dilemma for a clinical therapist as the question is—who do we refer to if we do not feel as though we can provide the services a patient requires?

If a patient does not have an appointment already with another vision professional, I assess their symptoms and etiology to try to determine the best fit. If there is not a clear determining factor, provide patients with a list of both the optometrists and MDs in the area. Be sure to also explain the difference between the two, and help guide the patient in deciding which professional makes the most sense for them.

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I hope this provided you with an intro into vision tied into occupational therapy, along with the professionals who are rocking that world!

Occupational therapists are well-suited to treat visual dysfunction and adult therapists would benefit from increasing their knowledge and competency for assessment and treatment to ensure our expertise in this field (peds OTs—I know you guys are already doing an awesome job!).

For on vision and occupational therapy, be sure to watch for a follow-up to this post to learn more about vision assessment and treatment!