Charles Shidlofsky, OD, FCOVD
A fundamental question for many in the neuro-optometric vision rehabilitation world is whether we should embrace nonoptometric professionals’ role in caring for patients — or view it as a conflict.
Some people are concerned that if we teach physical therapists (PTs) or occupational therapists (OTs) about neuro-optometric rehabilitation they will take business away from optometry. But there are at least three very good reasons to share care.
We need them. Other professionals can bring valuable expertise to the patient’s care. For example, in neuro-optometric rehabilitation, we routinely treat patients with balance problems. I work with the patient on the visual process — which may make up as much as a third of their overall balance issues — but they will likely also need to see a PT for help with proprioceptive and movement processes. In one recent case, in which an unknown neurological event caused sudden-onset tremors and nystagmus, I treated the patient with partial occlusion, but I also referred her to a functional neurologist, a movement specialist and an immunologist. We need to respect the strengths that each profession brings to the table and be able to coordinate with each other to ensure the patient gets the care they need.
They need us. It’s important to educate other professionals about what optometrists and neuro-optometrists can do to help them. Many of the cornerstone elements of vision rehabilitation, such as lenses, prisms, occluders, filters and other optical devices, are outside the scope of practice of an OT or PT. While there are areas of overlap, including working on oculomotor and convergence skills, those treatments are rarely sufficient to get to the root of visual dysfunctions. By educating OTs and PTs about neuro-optometric rehabilitation, I find that referrals from those professionals increase – not the other way around.
The setting demands it. Therapists who work in rehabilitation hospital settings have the opportunity to work daily with patients to help them regain skills lost due to a stroke or accident. By working together, we can get the patient on a faster road to recovery. A common scenario might be for me to prescribe specific prism lenses for the patient. I write an order that the patient should wear the prism lenses for occupational therapy activities for 5 days, for example. Or, I might ask the staff OT to work on visual-spatial skills the first week and monocular motor skills the next. These are activities that can take place at the rehab hospital until such a time as the patient is released and can return to my office for further evaluation.
It’s hard to be good at everything. I’m a firm believer in calling for help when you don’t know the answer. It behooves us to have a wide circle of professional “friends” to call upon — from OTs and PTs to optometrists with different areas of expertise, ophthalmologists and more. Ideally, we should seek to develop relationships with these other professionals that are built on mutual respect of each others’ skill sets and we should establish a clear path for returning patients to the referring doctor’s care. This type of co-treatment ultimately is all about helping the patient recover to maximal performance by stimulating neuro-plasticity via frequent repetition.
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Charles Shidlofsky, OD, FCOVD, is clinical director of Neuro-Vision Associates of North Texas, a multi-office specialty clinic serving children and adults. He is a member of the medical staff at Baylor Institute for Rehabilitation-Frisco and Health South-Plano and Fort Worth. Shidlofsky also serves as a consultant for several Texas-based rehabilitation centers, including the Centre for Neuro Skills and Pate Rehabilitation. In addition, he is secretary/treasurer of the Neuro-Optometric Rehabilitation Association.
Disclosure: Dr. Shidlofsky reports no relevant financial disclosures.