VTOD.org Editorial: A View from the Ivory Basement (February 2009)

Bill B. Rainey, OD, MS, FAAO, FCOVDA
VTOD.org Editor and Administrator

The Psychology of Optometry

Those who desire to receive the best possible health care often insist on being treated by doctors who practice "holistic" medicine. According to my Dorland's Pocket Medical Dictionary (22nd edition, 1977 - give me a break, I used it in optometry school!), holism is "the conception of a man as a functioning whole." Does this mean there are doctors who do not practice holistically? If they do, then IMHO they are not very good doctors.

Similarly, many patients or parents of children with vision-related problems are advised by friends, family, teachers, or professionals to only go to a "developmental", "functional", or "behavioral" optometrist. How does one know if an optometrist can be considered to practice in one of these "specialty" categories? Unfortunately, there are no standardized or commonly accepted definitions for these terms. It seems like the best way for an optometrist to be identified as developmental, functional, or behavioral is to simply state that they are. The only formal post-graduate specialty certification beyond state licensure that currently exists in optometry is Fellowship in the College of Optometrists in Vision Development (FCOVD). This is an earned designation, coming only after many hours, weeks, and months of mentoring, study, and examination. Post-graduate advanced academic degrees, primarily master's or PhD degrees, are often earned by optometrists, but these have not been used for specialty certification. Fellowship in the American Academy of Optometry (FAAO) is also a distinction earned by many optometrists and vision scientists, but this is not a clinical certification.

So, being the obsessive-compulsive type of person that I am, and being true to my undergraduate degree, I sought answers about terminology from psychology. I found some answers in a textbook called Introduction to Psychology: Gateways to Mind and Behavior, 9th edition, written by Dr. Dennis Coon (2001). In this excellent basic psychology text, Dr. Coon defines developmental psychology (on page 4) as the study of "the course of human development, from conception until death." This definition could easily be extended to optometry, especially considering the development of vision disorders like myopia (nearsightedness), amblyopia (lazy eye), and strabismus (turned eye). By understanding the development of these and other conditions, it is reasonable to think that optometrists could better treat them. That sounds pretty good, but, why wouldn't all optometrists practice developmental optometry? And, if they don't, what distinguishes a developmental optometrist from . . . well . . . something else?

Dr. Coon defines functionalism with respect to psychology (page 9) as "an interest in how the mind functions to adapt us to our environment." This is a bit different from Dorland's, which defines functional as "affecting the function but not the structure", as opposed, of course, to "structuralism." Dr. Coon goes on to say (page 10) that "functionalism was soon challenged by behaviorism, the study of overt, observable behavior." Dorland's Medical Dictionary defines behaviorism as "the psychological theory based upon objectively observable, tangible, and measurable data, rather than subjective phenomena, such as ideas and emotions." So, one could probably apply this terminology to optometry. But, can an optometrist be both functional and behavioral? What about developmental as well?

Another complication in this ambiguity of terminology is the use of the prefix "neuro-." Can an optometrist be considered to be a "neuro-optometrist?" Or, maybe a "neuro-developmental optometrist?" The International Neuro-Optometric Rehabilitation Association (NORA) "emphasizes treatment modalities designed to optimize the frequently neglected visual-motor, visual-perceptual and visual information processing dysfunction in the neurologically affected person" (http://nora.cc/content/view/106/151). Are these different from developmental, functional, of behavioral treatment modalities? Or, are they subspecialty modalities within these main specialty categories? And, again, how does one know that an optometrist practices in this way? Dorland's Medical Dictionary defines neurology as "that branch of medical science that deals with the nervous system, both normal and in disease." That seems like a pretty broad definition. And, if this definition is considered, wouldn't all optometrists be neuro-optometrists if they manage vision problems, since vision is part of the nervous system?

Rather than clarifying the profession, and helping patients to better choose their health care providers, it seems to me that this terminology may actually blur things a bit. How am I to answer the patient's question "What exactly is a developmental (or functional or behavioral or neuro-) optometrist?" Other than the possible exception of FCOVD status, there does not seem to be any consensus within optometry, so how can others outside of the profession understand what is meant by these terms? When I have asked other optometrists about their understanding of these terms, responses have included "vision therapy is developmental optometry," "behavioral optometrists practice behaviorally," or "they all mean the same thing, only some terms are older than others." I feel much better about my own lack of understanding when I hear the most common answer "I really don't know."

According to Webster's Ninth New Collegiate Dictionary, psychology is "the science of mind and behavior." So, can optometrists who claim these specialties also consider themselves "psychologists?" Not according to thefreedictionary.com, which defines a psychologist as a "person trained and educated to perform psychological research, testing, and therapy." But, thanks to my bachelor of science degree in psychology, it looks like I can call myself a psychologist. Or, better yet, maybe a "psycho-optometrist." I'm sure many of my friends and colleagues would agree with that one.

It is my belief that there needs to be some agreement within the profession on standardized and accepted definitions of developmental optometry, functional optometry, behavioral optometry, and neuro-optometry. Only then can we communicate adequately with our colleagues in other professions, and with our patients, for whom we want to provide the best possible health care.

Dr. Bill Rainey (aka Brainey)