During my freshman year at Pace University, from the moment I stepped into Dr. Melvin Kaplan’s office in Tarrytown, NY, I knew that what he did as an optometrist was different.
His office looked like nothing I had seen before: there were picture charts on the walls, trampolines, swinging balls, and he could perform a complete visual evaluation on a non-verbal, autistic child. He knew more about a person and how they functioned by assessing their visual system than the person themselves did!
I was in awe of the things that I saw and the impact he had on the growth and change in his patient’s visual, academic, athletic, and professional performance. This sparked an interest in me. The more I learned about the field of vision therapy and rehabilitation, the more curious I became; this curiosity has become my passion and fueled my optometric career over the past 16 years.
What is vision therapy?
Vision therapy (VT) is a specialty within optometry that helps you better understand a person’s visual system and how they are functioning. Your approach to their visual system is to understand wholly how they utilize their eyes and the integration of the visual system with the auditory, vestibular, and cognitive systems.
This deeper understanding of function allows you as a practitioner to identify weaknesses in a person’s system that may be affecting their ability to have clear, comfortable vision and work at peak visual performance.
To be successful in vision therapy, a person must be interested in understanding their patients, want to take the time to listen, perform extensive testing, and treat accordingly. The public perception is that if we have "20/20” vision, we have the best vision possible.
Unfortunately, having “20/20,” literally only tells us how clearly we see at 20 feet. It does not tell us how a patient is seeing or the quality of their vision. Further, “20/20” does not tell us if a patient is able to maintain single vision for any length of time while reading or if they experience headaches or eyestrain.
A vision therapy and rehabilitation work-up can often take upwards of an hour or more to really understand all the pieces to the vision puzzle and how your patient is functioning.
General treatment protocols for vision therapy
Treatment then involves weekly or bi-weekly appointments, ranging from 30 to 60 minutes per session, over the course of months (sometimes years) to improve someone’s ability to gather, process and integrate visual information efficiently. Vision therapy can be done on a wide range of patients.
These can include young children to geriatric patients with issues like strabismus, amblyopia, binocular vision dysfunction, and oculomotor, accommodative, or perceptual difficulties. Additional treatments for post-concussion/traumatic brain injury populations, as well as vision enhancement (“sports vision therapy”) for athletes, also fall under the purview of vision therapy.
Vision is truly a learned process, and there is always room for improvement!
The pros of VT as a specialty
Just like any specialty in optometry, there are a multitude of ways to integrate this into your career. You can dedicate your whole practice to vision therapy and rehabilitation, supplement your primary care practice with it, or work within a Veterans Affairs (VA)/Hospital-type setting providing this care.
The biggest pro of this specialty is that it is beyond rewarding: you are changing people’s lives daily. You get the opportunity to spend time with your patients, get to know them, and improve their vision and visual performance. Moreover, if you practice this specialty, you have autonomy over your time and the type of care you are providing.
I do not consider this necessarily a con, but often a barrier to entry for many practitioners into the world of vision therapy is that it does take time to evaluate and treat these patients. It is not realistic to practice this specialty if you are expected to see three to four patients/hour.
The cons of VT as a specialty
If you are interested in vision therapy or bringing vision therapy into an existing practice, the mindset around how long an exam should take and follow-up care needs to be adjusted! Setting up realistic expectations is key to success.
The biggest con, in my opinion, is tackling the “take insurance or don’t take insurance question.” Vision therapy is not often covered by many insurances, so you have to decide if you want to deal with the headache of getting prior approvals, chasing patients for services not covered, or very low reimbursements.
The flip side to this is that depending on the demographic you are servicing, it may be difficult for patients to pay out of pocket for your services. Regardless of your answer to this question, vision therapy can and is a profitable specialty care within optometry.
Where to start with vision therapy
If you are a high school/undergraduate student:
If you are just getting started in thinking about optometry as a career and possibly vision therapy, the best thing to do is get out there and shadow! Log in some hours with a local optometrist who can show you what their days look like and perhaps even join the practice to work in the office. First-hand experience is by far the most valuable experience!
If you are a current optometry student:
Depending on your school of optometry, there are varying degrees of exposure and clinics, but if you are interested in this field the best thing to do is get yourself in as many clinics and externship rotations as possible to get exposure.
For example, during my 4th year of optometry school, it was required to do a general pediatric/vision therapy rotation, but then I chose to do an additional rotation in vision therapy/pediatrics that gave me a wider exposure to the field.
I was placed in a strabismus clinic, head trauma clinic, preschool vision therapy, and had the opportunity to go to Woodhull Hospital and Ezra Medical Center, both of which provided exposure to different populations and needs within this field.
Take your courses seriously and create connections with professors who are well-versed in vision therapy and rehabilitation. Spend extra time with them and learn as much as you can. Also, getting involved in clubs (such as the College of Optometrists in Vision Development [COVD]) or attending lectures or events that expose you to the field is always recommended.
Should you do a residency?
Residency is always a personal decision: it is not required to practice but can open the doors for different opportunities (academia, hospital, VAs, etc.) in the future.
The first question you have to ask yourself is, do you want to do a residency? If the answer is yes, then the second question you must answer is how do you see yourself practicing? Vision therapy is unique because there are so many ways to practice and integrate this specialty into your career.
Do you want to stay in academia? Do you plan to do private practice? Are you interested in both vision therapy and ocular disease—perhaps a VA hospital may be a great fit to accommodate both of those interests.
The perks of doing a VT-based residency
You also want to consider your approach to vision therapy and choose a practice that aligns with your philosophy. My best piece of advice is to visit the different residency sites to see what each program offers and what your day-to-day activities look like because each site varies and can give you a wide variety of opportunities.
For example, my residency was heavily vision therapy-based, but I also had exposure to primary care, ocular disease, and contact lenses, as well as a private practice module to help build my business knowledge.
In my opinion, a residency in vision therapy is invaluable; it gives you the time and space to really expand and solidify your knowledge base and gives you an extra year to build your confidence in treating complex cases. However, I want to make it clear that if you choose to not do a residency, it does not mean that you are not going to be a proficient vision therapy doctor!
There are so many resources to further your knowledge base. The whole community of vision therapy doctors is always open to sharing their approach to vision and helping mentor as well!
Your first job and practicing
As with any career path, your first job is likely not going to be your last. Practicing vision therapy sometimes takes a few tries to find the right fit, and it is never too late to start providing this service. It is important to note that being proficient in this area of optometry sets you apart from your colleagues and often makes you quite marketable in the job search.
There is no “right” way to incorporate vision therapy into your career. Every vision therapy doc does things a little differently in terms of scheduling, insurance, who is doing the vision therapy (vision therapist or the doctor themselves), one-on-one sessions vs. multiple patients, etc.
The specialty care within optometry affords you a lot of flexibility in figuring out how you want to practice while improving patients’ vision and making a living.
Dr. Zilnicki's personal journey to becoming a vision therapist
I had initially gone to visit Dr. Kaplan’s office at the suggestion of my honor’s college supervisor, who knew I was struggling with what direction to take my biology degree. I knew I wanted to be a doctor of some sort but did not want to go the traditional medical doctor route.
I was intrigued by occupational therapy but also had an interest in either dentistry or optometry. He suggested I visit Dr. Kaplan’s office, thinking this was the perfect combination of what I was looking for. He was absolutely right!
What was intended to be just a day of shadowing turned into a job opportunity. I began working for Dr. Kaplan as a vision therapist, and soon after, I applied to SUNY Optometry’s 3/4 Program with my undergrad (this program allows you to complete undergrad in 3 years and finish your 4th year at optometry school).
I was a late entry into this program as a sophomore in college, as most often students apply to this program in high school, but my tenacity and constant follow-up in joining the program got me in.
Other schools also offer this joint degree program, including the New England College of Optometry, Salus University, and NOVA. To find an extensive list of all optometry schools and programs that are offered, visit ASCO’s Future Eye Doc website.
Dr. Zilnicki's steps for pursuing VT in optometry school
I entered SUNY Optometry in August 2009, knowing that I was going to pursue a career in vision therapy. I was steadfast in my interest while at school—I did extra clinic sessions observing in vision therapy and rehabilitation clinics that normally students did not get to do, got involved with the COVD club, created relationships with the doctors prominent in the field, and chose my external rotations with an emphasis on vision therapy.
As I neared 4th year, I knew that I wanted to go into private practice and chose to pursue a private practice residency with Dr. Barry Tannen, Dr. Nick Despoditis, and Dr. Ivan Lee at Eyecare Professionals, PC in New Jersey. This year was a pivot year of growth, both professionally and personally. This experience gave me the tools and confidence to open a vision therapy and rehabilitation specialty care practice 1 year after finishing my residency.
My partner, Dr. Jessica Licasui, and I will be celebrating our 8th year in practice this August (2023). Our office is unique in that we do not have an optical and only take very limited insurances. We have been able to grow our business to be a thriving specialty care practice that focuses on vision therapy and rehabilitation! To learn more about the office, click here.
Vision therapy resources
The field of vision therapy and rehabilitation is always growing and changing—you will never stop learning! Below, you’ll find an extensive list of all resources to build your knowledge base that is good for students interested in the field and optometrists!
Vision therapy organizations
1. College of Optometrists in Vision Development
The COVD, soon to be the “Optometric Vision Development and Rehabilitation Association,” is the go-to place for all things vision therapy! They have an annual meeting that connects doctors from across the world with incredible speakers, workshops, and time to connect and mingle with your colleagues.
Their website provides a plethora of information on vision therapy for both the doctor and patients. They also have a longstanding fellowship program that indicates advanced competency in the areas of vision development, visual information processing, binocular vision, vision therapy, and vision rehabilitation.
The process is lengthy, and will challenge you as a practitioner, but elevates your knowledge and proficiency in this specialty.
2. Optometric Extension Program Foundation (OEPF)
The Optometric Extension Program Foundation was founded in 1928 by AM Skeffington (“The Father of Behavioral Optometry”) and EB Alexander. Since then, OEPF has served as an international organization that is dedicated to the advancement of vision therapy and rehabilitation by understanding vision and the visual process.
OEPF offers a lot of continuing education, but the core courses that run constantly are:
- The Art & Science of Optometric Care—A Behavior Perspective
- VT 1—Visual Dysfunctions
- VT 2—Learning Related Visual Problems
- VT 3— Strabismus & Amblyopia
Click here for their upcoming courses! They have recently created a certification process to designate excellence in behavioral and neuro-optometric vision therapy and rehabilitation.
3. Emergent Vision Therapy
Emergent Vision Therapy, created by Dr. Ben Winters and his certified optometric vision therapist (COVT), James Smith, has become the leading source of online courses. They offer a “101” and a “201” course that can be utilized for the vision therapist, but even for those doctors who do not have a strong binocular vision foundation.
These courses are accompanied by a COVT mentor, and a final written and oral exam to ensure competency. Find more information here!
Emergent has recently partnered with world-renowned Dr. Robert Sanet to provide his five-weekend series (usually hosted in San Diego to a small group) to you at your home/office! This course is broken down into ~150, 300 to 45-minute segments of video with an additional 500 pages of commentary by Dr. Leonard Press. You can find more information here!
4. Neuro-Optometric Rehabilitation Association (NORA)
Neuro-Optometric Rehabilitation Association serves as the best resource for learning about how to manage patients with acquired brain injuries. This group is made up of multiple different disciplines, not just optometry, to provide education, resources, and a community of doctors. Click here for more information about their upcoming annual meeting!
5. Vision therapy seminars—hosted by Dr. Brenda Montecalvo
Dr. Monetcalvo is a pioneer in vision therapy and rehabilitation and a mainstay on the lecture circuit. She lectures often virtually and also offers a yearly series at her Cedarville Horse Farm. Click here for her upcoming lectures.
6. iHeartVT
During the height of the COVID-19 pandemic, iHeartVT was created and has continued its mission of connecting vision therapy professionals across the world. This platform allows you access to an abundance of archived lectures on every topic you could think of, and there is new content constantly coming out for $20/month.
The best part about this site is you can search for a topic you may be interested in, and you’ll be provided with previous lectures that you can access!
Additional VT resources
Books:
- The Best: Dr. Leonard Press, Dr. Marc Taub, and Dr. Pam Schnell—Applied Concepts in Vision Therapy 2.0
- For The Basics: Dr. Mitchell Scheiman and Dr. Bruce Wick—Clinical Management of Binocular Vision
- The Classic: Dr. John R. Griffin and Dr. J. David Grisham—Binocular Anomalies: Diagnosis & Vision Therapy by Griffin & Grisham
Journals:
- COVD’s Quarterly Journal: Vision Development & Rehabilitation
- OEPF’s Quarterly Journal: Optometry & Visual Performance
Websites:
Podcasts
Final thoughts
Lastly, coming from a doctor who has dedicated her career to vision therapy and rehabilitation, I can tell you that this specialty is incredibly rewarding and worth pursuing.
There is a wide spectrum of ways to incorporate vision therapy into your career, and it gives you the opportunity to set yourself apart from your colleagues and create a niche in your community!
