Visual Integration

The Impact of Integrative Optometry

From Dr. Heidi Wise, OD, FCOVD

A New Approach: Integrative Optometry

Optometry is a bit different than many other medical disciplines. It is one of the few that really has a broad spectrum of potential applications, yet has no designated sub-specialties from a board certification viewpoint.

I have been fortunate enough to progressively take an interest in all of these areas. I started my career over 13 years ago, as a Primary Care Optometrist. I have been responsible for a patient’s brain tumor being diagnosed and another patient receiving a cardiac stent, because of findings during their comprehensive eye examination. Learning-related vision dysfunctions are what pulled me towards Behavioral Optometry; there is an amazing joy in watching a “problem” student blossom into a confident, cooperative learner. Working with an acute rehabilitation hospital provided me with an appreciation of just how hard it is to learn to walk again if your eyes no longer work together, which may cause the floor to appear to shift or be tilted.

Now I am involved in what I am calling Integrative Optometry, with much thanks to my wise physical therapist colleague, Jason Masek, for the suggested term. This really incorporates all the above areas and applies them to the function of the organism while postural neutrality, as defined by PRI principles, is maintained. This neutrality then becomes the basis of evaluation and treatment plans, which must be established prior to, or in conjunction with, addressing typical vision needs, such as visual clarity. As we have seen is the case with several patients in the last few months, how clear their vision is can change as their body struggles to find stability. This is not so different from the over-action of an inappropriate muscle to compensate for the under-action of an appropriate one, which produces predictable patterns familiar to the therapist with a background in PRI principles. For others, how well they are able to function using both eyes together, called binocularity, may change. For these patients I would not want to work on binocular skills, which are visuo-motor in nature as well as related to visual-perception, unless I knew that they were neutral, as defined by PRI, while they were engaged in these activities.

There are some behavioral optometrists out there who do look at the effect of different lenses on balance. Primarily, from what I have experienced, this is using prisms or even various patching methods, such as binasal occlusion. These approaches have tremendous value, especially for patients with any type of brain trauma, which is why they have been discussed in PRI courses and will continue to be. What has been seen through experience is that these approaches tend to have a great influence in only one of the patient’s spatial planes. The exciting thing is that we are now able to effect changes for patients in all three spatial planes! To make it even more powerful, the assessment of not only neutrality, but also of a patient’s physical dynamic function takes place because of the simultaneous assessment by both disciplines. As much as I can learn about balance and gait patterns, there is no way for me to decide which lens gives the patient the most of the desired effect, but also does not put the patient in a position that they will have no ability to maintain.

For some patients, there may be more than one lens that will put them into a neutral position. One may give them more power, while another may make them so weak, because of habitual underuse of correct muscles, that they will use another incorrect strategy to try and compensate. These nuances are what the experienced physical therapist must use to assess the best visual function that can be provided. My concern is how much the patient will be able to tolerate the proposed visual prescription. We both are additionally concerned with the role the vestibular system is playing and whether the integration of this system is being adequately and appropriately addressed.

We will be addressing and identifying new agonistic patterns of muscular movement, that are polyarticular in nature, and incorporate the PRI Vision principles. We are looking at visual patterns, including the eyeglass prescription, as they relate to defined PRI patterns. This will be part of the spring PRI Interdisciplinary Integration course.

I can’t begin to tell you how excited this concept of true integration makes me! Vision is both motor and perceptual in nature, and if you think about it, so is every other system in our bodies that has voluntary movement. The idea of the two disciplines, that can facilitate changes in these areas, finally working together is, for me, a tremendous step forward in patient care. Integration is the key!

Until the next time, please feel free to contact me or Ron about questions you may have. This Integrative approach is having amazing results on patients who have never had long term relief from their problems.

Heidi Wise, OD, FCOVD