This episode is more than just a heartwarming chronicle of success stories. It offers a captivating glimpse into Dr. Cameron McCrodan’s unique perspective. He demonstrates how optimized vision can be a powerful tool for combating learning disabilities, head trauma, and even the dark depths of suicidal ideation. With his engineering background at its core, he dissects the complex mechanisms of visual processing, showcasing how seemingly minor tweaks can unlock hidden potential in our perception. This episode shines a light on the immense potential of VT as a therapeutic approach. His pioneering work in optimizing vision therapy offers a new lens through which we can view the potential of this field, paving the way for a future where vision is not just about seeing clearly but about unlocking the full potential of the human mind.
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From Vision Therapy Skeptic To Expert – Dr. Cameron McCrodan
Thank you so much for taking the time to join me here, as always, to learn and to grow. I truly appreciate all the support. As I’ve said, the show has been growing and it’s been thanks to all the support, all the reading, all the sharing and the liking. As always, I’m going to ask a quick favor off the top, which is if you get some value out of this episode, please do share it with a friend. Send a link to their text message, Instagram them, put it on LinkedIn, wherever you can, and let people know that I have this amazing guest on.
Dr. Cameron McCrodan is an Optometrist based in Victoria, BC. He is a 2011 grad from Waterloo and is also a TEDx speaker. We’re going to touch on some of the same things he talked about in that TEDx Talk. He is a self-proclaimed skeptic turned expert in vision therapy. I love that approach because I think many of us are skeptics and would love to hear from somebody who’s become an expert. His clinic in Victoria is called Opto-mization, but he also practices in Brooklyn, New York and I think that’s an interesting thing I’d love to touch on. Thank you so much for joining me here, Cameron. I appreciate it.
Thanks for having me. I’m excited to be here.
Why don’t you give me a little bit of an intro, if you don’t mind, for those out there who don’t know you that well because you have an interesting background before we even got into optometry? Tell us a little bit about that.
I grew up wanting to be an engineer and I always wanted to be an engineer since I was a kid. I liked inventing things. I liked problem-solving and I wanted to invent stuff that would help people and change the world in some way. As I was going through engineering school, it started to feel like I was going to end up living in Northern Alberta, working behind a computer. That was going to be about the extent of my engineering when I was done.
Pretty quickly, I decided I wanted to do something else. To his credit, my dad made me interview many different professionals, lawyers, dentists, doctors, surgeons and optometrists. Optometrists seemed to be some of the happiest ones of the bunch. Good work-life balance. They weren’t on call and all these other things. I was like, “Maybe I’ll go to optometry school.” I did the courses to go to optometry school. Something funny that most people may not know is I actually never had an eye exam before optometry school. My first eye exam was at optometry school.
I’d never actually had an eye exam myself and at an optometry clinic or anything. I went there for it. Getting through and getting out of optometry school and those who remembered me from our classes, I had a couple of run-ins, I think, with some of the faculty for stuff when I didn’t think things were things were necessarily being organized or taught in the way that benefited the students the most.
Knowing you the little bit that I do know you, I can see that happening that you would be like, “This is not the best way to do this. Let me show you how to do this right.
I think that was a thing of mine since I was a young child and probably one of the reasons that my dad pushed me into doing something where I’d be working for myself or whatever. He’s like, “If you end up in a government position, everyone’s going to be in trouble.” Probably similar to optometry school, similar to my elementary school, I was usually either a prof’s favorite student or their least favorite student. It was generally completely polarizing, depending on how they approached their job.
I got out of optometry school and pretty soon, I didn’t like practicing primary care optometry. It wasn’t doing it for me. It wasn’t checking the boxes of that engineering part of me that wanted to solve and deal with more complex problems. I was actually going to leave optometry. I was six months out. I saw my sister graduate from dental school and I was like, “If I’m not going to enjoy my job, I’m going to go back to dental school and I’m going to make six times as much money hating my job so that I can retire earlier.” I’ll still hate it, but I’ll make way more.
A friend actually introduced me to the area of the vision therapy side of things. Being a very natural skeptic of everything, I was usually like, “Eh.” I went and did a course, arts and sciences, with OEP, and something clicked about one of the guys talking there. I realized pretty quickly I was like, “This is actually the engineering of our visual system.”
Pretty quickly on, I realized that my sister struggled in school growing up due to a problem with how her eyes tracked and moved and worked together. It became personal to a degree as well. I started getting those things figured out. It was basically within a year and a half of graduating optometry school, I opened my first vision therapy clinic and it snowballed from there. I left primary care practice in 2014. I retired from primary care. That’s what’s taken me all this way.
We had a course called Visual Perception. Does that sound like something that you had? It was a very theoretical type of course in that it basically showed all these neural networks, but then it looked like something out of an engineering or electrical engineering type of course. There are lines going to other lines in boxes leading to other boxes. Now that you’re talking about this, that seems like a course I feel like you would’ve enjoyed.
To be honest, I didn’t even enjoy the course that much because there was no practical application for it at the time that I was doing it. To me, my engineering part has always been on the side of, “How do we actually apply this, and how do we do things that way and about the process and applying stuff?” I definitely remember that course, but I wasn’t a fan of it at the time. I think if I went back to take it, I’d have a lot more interest in it now.
Absolutely, I bet you would now. In fact, you’d probably be teaching the course. Let’s talk about the skeptic turned expert. I think this is important. Maybe you could help me clarify something along the way here. With vision therapy, like you said, like your personality in school, you’re polarizing. People love it, and those who love it are obsessed with it. It’s the best thing in the world. There are people who are like, “I don’t understand it. I hate it and don’t want to touch it.” There are also people who don’t think it works, like they totally discount its validity entirely. Why is it so polarizing?
There are a number of reasons for this, but from where I came from, I can remember literally telling a family when I was working in primary care. I’m like, “Don’t do the vision therapy. That’s total snake oil, total BS. They’ll take your money and you won’t get anything out of it.” Go do some pencil pushups, for example. I think one of the fundamental problems for all of this comes down to our model of vision to a large degree. I think there are two parts to it.
I think one is how we’re taught to think and then I think two is the model of vision. I guess actually maybe there’s a third because there’s a little bit of political stuff in there too. When we talk about model of vision, for most of us, when we think of vision, we’re thinking of clarity, ocular health, what does it take for somebody to see clearly, the refractive stuff and then again, physical health of the eye. It’s like transmission back to the brain, and you magically have vision.
What we don’t realize, though, is that our brain, essentially what’s coming in our eyes, is a bunch of 1s and 0s and our brain is actually decoding all of that to make sense of what we’re seeing. By sense, it’s not even knowing what you’re seeing, but where is it? When reaching for your microphone, your brain calculates how far away that microphone is from you. It’s actually using the visual feedback as you move your hand to keep adjusting your motor movements for that.
If you position your eyes on something, if you converge on something or move them, your brain has used the visual information to essentially get the coordinates of where it wants to position your eyes. It’s like if you’re going to fire a rocket or throw a baseball, you want to know the coordinates of where you want it to go and then you make the action based off of that.
I think part of the issue comes down to a misunderstanding of some of those things. I also think a misunderstanding of vision therapy, the way that I was taught, vision therapy was about making the eye muscles stronger. When a child goes from learning piano, like from not knowing how to play it to playing it, the difference isn’t in the strength of the muscles of their fingers. It’s that they’ve learned how to coordinate their fingers in the appropriate way to play the piano. They’ve learned how to read the music appropriately to get that input and turn it into an output.
That was a huge shift for me in understanding that effective vision therapy isn’t about strengthening muscles. It’s actually about re-patterning how the brain controls the muscles and processing the incoming information. That’s what makes a difference. Another one of the reasons that we have an issue with things. One of the other pieces too is also syntax. What I mean by syntax is this. If you take a bunch of people, and this is where a lot of the fighting about vision therapy comes, you go, “Vision therapy helps kids with reading problems.”
That’s a problematic statement because not all kids with reading problems have vision problems that are part of their reading problem. That’s like being like antibiotics help people who are sick. No, only if they have a bacterial infection that’s leading to the sickness. There’s this huge issue within some of the studies, research and publications of exactly this problem. It’s the same thing post-concussion. If you go look up some of the more recent reviews that are published about vision therapy and post-concussion stuff, one of the big issues there is that, again, it’s the same syntax problem.
Vision therapy should never be used to treat post-concussion, but it can be used effectively to treat psychotic issues that have come up as a result of concussion. That doesn’t mean every post-concussion case. That’s where a lot of the arguing and academia actually happens. It comes down to syntax and understanding of those things. That’s one big place where I see that alone spins out into most of the argument about vision therapy.
Another issue, too, I think, is that vision therapy also tends to sometimes attract slightly more eclectic personalities or things that seem a little bit out there. You do get more people making claims that may not be based on logic and optics and understanding how our neurology actually works. I think that also gets some of a bad rap as well. There are a couple of different pieces there.
There definitely are some of those more outliers that I think can affect the overall view of the specialty, which is unfortunate. That’s the case in a lot of industries and in a lot of professions. You get the people who go a little too far over to one side and they tend to be the loudest voices often in those ones as well.
There’s often truth within some of what they’re talking about. Take Irlen Syndrome stuff, for example. I’m sure you’re familiar with Irlen Syndrome. Do the colored filters help you feel better? Now, the problem they have is another syntax problem. If the colored filters help you, they’ve decided you have Irlen Syndrome. That’s essentially the equivalent of saying, “If your arm hurts and you take Tylenol and Tylenol helps you, you have Tylenol Syndrome.”
No, you have a hurt arm and the Tylenol, yes, it makes it feel better, but it doesn’t mean that your fundamental problem is a lack of Tylenol. The same thing’s been shown with Irlen where the fundamental issues are actually binocular dysfunction problems behind it. The Irlen filters help. It’s a misnomer to then use that as a diagnosis. I think that’s where the engineering part of me gets so into some of these things because you can cut through most of the arguments when you understand what’s going on and then the language behind it that’s causing people to fight about it.
When you use logic, it’s funny how sometimes you can actually get to the right answer. Let’s talk about your own skepticism and then how you decided VT was the right path for you.
As I said before, I told multiple patients that VT was total snake oil and BS. It’s all also funny because when I have a parent in the office who I can tell is thinking that, I’m like, “I was the biggest skeptic of this in the beginning too. I get it. Ask the hard questions.” What wound up bringing me around, though, was a number of things. I don’t know. Have you read much Scott Adams?
No, I have not.
Scott Adams is the guy who did Dilbert. You’ve read lots of Dilbert, but he’s written a couple of neat books and in one of his books, one of the things he talks about is that our schooling often teaches us how to think we’re taught how to think about things. Within optometry, and I don’t know about your school, but a big one for ours was like you listen to the history, you do your tests, you make the diagnosis and for treatment, you do what the manual says for treatment for that diagnosis.
There are new peer-reviewed studies that come out sometimes. If those say to do something else, then you do something else for it. In engineering, how we’re taught to think as we go, “What are the symptoms? What problem is somebody or something having? Let’s investigate any system that could be responsible for those systems, obviously within our scope, but investigate the systems that could be responsible for it. Are any of those systems not working properly? Do we have a way to help that system work better? If so, what do we do?” That’s more the engineering mindset of it. I think that’s where my skepticism started to disappear with things because I was always interested in the mechanisms of stuff. Have you heard people talk about microprism before?
Yes, absolutely.
The way that microprism was originally brought up to me was as though it was like magic. It’s like, “Microprism. It’s this magical thing.” Having the engineering optics background, you look at it and you go, “What is the prism actually doing?” Thankfully, I had a great instructor who talked about this a little bit at one point, but what’s the prism actually doing? It’s actually shifting depth and spatial perception.
We know that when you move your head, your inner ear sends signals to your visual system telling you how much your head is moving so that you can compensate with the correct eye movements. Essentially, the two systems are linked together and integrating properly. If your inner ear says things are moving and your vision tells you something different, we’re in trouble. That’s what seasickness is. You’ve got a mismatch.
When you change someone’s prescription positive, negative, magnification, minification or using prism, you can change the ratio at which they see the world move when their head moves. We know that by changing prism, magnification, or minification, you can change how quickly somebody sees the world move when they move their head. That’s called VOR gain. That can be the difference between whether somebody feels stable or not.
You can also actually use the lenses to change somebody’s perception of depth and space. You can use lenses to make somebody think things are further away from them, closer to them, further to one axis or another. All of a sudden, thinking about these things that are talked about as like magical in VT, you’re all of a sudden going, “There’s actual optics here,” and we know the process of how the brain uses the vision. That makes linear logical sense.
Some of those things that you’re talking about, minifying, magnifying, changing the spatial perception, we do those inadvertently, accidentally, unintentionally when we’re prescribing regular or whatever lens could be single vision could be progressive or whatever.
Every lens itself has these effects as soon as we start playing with somebody’s refraction. How many patients have you had before where they love how they feel in their contacts and they hate how they feel in their glasses?
Every day.
That’s often it because think about the two different worlds the person’s transitioning between. They’re going from basically a very natural VOR gain in the contact lens to all of a sudden, they’re at like a minus 4 or minus 5, their world actually looks and feels very different. Their brain has to reintegrate all these ratios differently all of a sudden.
I actually use that explanation. I love that. Thanks. I appreciate your verifying some of the things that I’m saying to patients. I’m sure I learned it in school or something, but I’m saying intuitively, “When you wear your glasses, it’s minifying or magnifying. Hence, maybe it doesn’t feel as comfortable as what you see through your contact lenses.” I appreciate that. Now, I’ll feel more comfortable when I make those statements. What part of VT would you say is maybe not as effective current perspective of understanding what VT does? Average person’s perspective of what VT does, what’s not effective? What maybe should we not be doing when we’re doing vision therapy? Is there something that should be disposed of?
Yeah. I think the one thing we should never be doing is treating symptoms without understanding why or knowing the mechanism. I think that’s one of the big problems that people assume. It’s like a kid has trouble reading. We’re going to throw vision therapy at them and see if that helps. No, if a kid has trouble reading, let’s make sure that all their cicades are accurate and work properly. Let’s make sure that they’ve got stable binocular vision the whole time and that their accommodative system can do what it needs to do and all these other things.
We should never treat symptoms without an understanding or knowledge of the mechanism.
If all those things work great, then from the VT world, there’s not anything to offer them. There’s more to test than that, just as an example. I think that’s what we’ve got to get rid of within it is the idea both sometimes within people within the profession and people outside of the profession that vision therapy is being used to treat this other condition rather than the visual things that are part of it.
A great example of that is autism spectrum disorder. Many kids with ASD have binocular vision problems that respond well to treatment, but you’re not treating the ASD, you’re treating the concurrent binocular issues that are there. That’s where a lot of stuff gets messed up. Same with dyslexia. You can have cases of dyslexia where there are no vision problems at all. A good friend of mine was like that.
I was so excited. I was like, “There’s a good chance eye tracking is part of your issue and we may not solve the whole thing, but maybe we can make it better.” We tested it. Absolutely not. I had nothing to offer. Whereas again, a lot of people may have dyslexia and may have significant tracking and binocular issues that mean that the parts of the brain involved in dyslexia aren’t even getting the information properly in the first place. They have both things. That again comes back to the syntax of what gets vision therapy misunderstood or in trouble that way. That’s what we have to stop doing. We have to be very clear about what it is we’re treating and the role that it plays.
An easy mistake to make and gets made a lot in general is painting everything with one brush or too broad of a stroke, saying, “Vision therapy helps with a bunch of these things,” but not defining in a much more specific way. It’s not just vision therapy. If we keep it with optometry, there are so many things. We can talk about that with dry eye, this happens. You probably have dry eyes. We could probably fix it now. You might have dry eyes, but it may not be related to the other thing, the other issue that you’re dealing with. I feel we tend not to separate these things enough, but using it for very specific scenarios can be super powerful.
We have to define those a lot better for people. We’re not making claims that are a little too audacious or whatever. Talking about students, learning and reading. Your TEDx Talk was primarily on that topic, but you do something else, which I teased right off the top. You go all the way to New York and you do some work there. I was so interested in learning about this. I’d love if you could share what you’re doing out there and the type of impact it’s having.
Coincidentally, a good friend of mine wound up getting me involved with the Orthodox Jewish community in New York. We wind up helping those kids with reading and learning stuff because they spend 8 to 10 to 12 hours a day reading. It’s a huge part of their life, a huge part of their community, a huge important part of their religion. The reading is so important. That experience taught me so much about all sorts of lens prescribing stuff, eye movement efficiency, and so much in that area. It was a pretty neat thing.
I haven’t been there since the beginning of COVID. My visa ran out. I’m in the process of getting that all set back up again. It was a pretty amazing experience. Especially, again, in a culture where reading is so important. A lot of the time here, how we treat it is like, “You can’t read? We use text to speech or whatever, or find something else you like to do in life.”
The next thing I want to talk about is the impact that you feel that you’ve had your patients then we’ll come back to BC. In that specific scenario, what things are you seeing? What are families saying to you? What impact is that having on people?
The difference in kids’ trajectories, their ability to sit and focus, and their ability to learn their frustration was massive. For families, if they had a child who was struggling in school, the family was worried because that kid would get frustrated. They’d often get ostracized a little bit within the community. They’d have a much harder time integrating. For the family, it was a massive concern. It meant everything to them if you could help normalize their reading and improve their abilities in those areas.
Normalizing is one thing, of course, that’s going to help relieve a lot of the stress.
Also, enhance.
Before we go into the thing I wanted to talk about, which was the impact that you have on patients’ lives, one of the frustrations I have about Western medicine is that we don’t talk about optimizing. We talk about fixing disease states. What about somebody who comes in and is functioning pretty well but wants to function better, optimize, or enhance? We don’t do enough of that in general.
When I go to talk to an MD like, “It looks like all my blood tests are normal, but I want to get a little bit better at this or have a little bit higher levels of this. What can I do?” They look at me like, “Why? What are you talking about?” We do the same thing with vision. “You’re 20/20. You’re good to go.” What kinds of things could we potentially be looking for that we can do for somebody who has normal vision function to enhance it?
Here’s the whole thing. When we talk about normal and what you mentioned with blood tests, is it normal according to who? Your blood tests are normal. Does that mean that you’re functioning well or does that mean that you’re in this area where they don’t consider you diseased enough to be a problem? That ties back again to that engineer’s mindset of going, “Based on the needs of your life, are there areas that we can make things work better?”
When we talk performance enhancement, I’ve got a race car driver where he sees pretty much 20/20 at distance, but we found out he had a very small binocular-like instability at distance, slightly vertical, slightly horizontal. Using the right lenses, we could keep his vision way more stable as he was ripping around the track at 200 miles an hour.
For him, better breaking times, better everything, better performance or around reading and focusing side of it. I’m actually a great example of that. I got through school pretty well, but I could only focus on 3 or 4 pages at a time. I was the first one done every exam in optometry school. I had a limited window. I didn’t even realize it at the time, but from the second I started writing the exam, I wanted to be done. I wanted out of there. I don’t think I even ever looked over an exam twice. I never double-checked my work until I did my board fellowship. By that time, I’d treated my own reading stuff so that if I wore my appropriate glasses when I sit and read, I could focus for much longer. I actually double-checked the test for the first time.
When we talk about performance enhancement, I think one of the big things we have to consider is that our human visual system isn’t made for our modern world. Our human visual system did not evolve for sustained periods of up-close work. Our visual system is meant to be scanning out there working more at a distance with intermittent times of up close. Quite frankly, our evolution hasn’t been selected for visual systems that work well past the age of 30 or 35 through our history, either. If people care, but we won’t get into how evolution works. The selective breeding didn’t happen for people over those ages with clear vision. That wasn’t a consideration.
If we work off of the understanding that our visual system’s not made for a lot of the modern-day demands, then we go, “How do we help improve how it works under these different scenarios?” That can include extended periods of computer time, extended periods of reading or other things that people are doing that, again, we haven’t evolved to do. How do we help them do it better?
Sometimes, it’s from a therapy side. Sometimes, it’s simply how we prescribe lenses for people. The tie into that, though is what you mentioned earlier. Be careful of the marketing for things as well. A lot of the company reps hate coming to my office unless they know what they’re talking about. Seriously, they’ll tell you. They’re like, “We’ve got a lens that focuses at all these different distances and there’s zero compromise.” I’m like, “Unless you’ve reinvented the Laws of Optics and the Laws of Physics, that’s not actually possible. You can’t have these different distances at the same time on the retina without some level of compromise. Let’s be frank about what the compromise is and then at least people can go into it in an educated manner.
Let’s be frank about the compromises. At least people can go into it in an educated manner.
I’d love to be a fly on the wall in a lot of these interactions that you have with people. Honestly, the other thing I want to do is learn from you and we’re going to talk about that a little bit more towards the end here because we will have the opportunity to learn from Dr. Cameron McCrodan. Before we get to that, the impact, I want to go back to that because I think this is powerful.
You have a very specialized clinic. You’re getting referred a lot of patients from different types of practitioners. People are coming traveling to come and see you. It’s something you’ve developed and built over the years. In those kinds of cases, when I talk to doctors who have those, whether in dry eye, in VT or some other cases, they can help people in a tough spot. If you can, share a couple of stories where you’re proud of things that you’ve done and where you’ve helped a couple of people who were challenged and weren’t able to get the relief.
One of the things that comes to mind almost right away because I was in tears in the office is I’ve had three people in three months tell me they had plans to commit suicide because of their headaches and dizziness. Each one of them had been facing it for two-plus years. Nobody had any real answers. They’d been through all sorts of stuff. In each one of those cases, actually, a huge part of their symptoms was actually a pretty severe binocular visual dysfunction. Sometimes, some visual-vestibular stuff happens in whatever else. Even the right glasses and lenses made such a difference.
I had a woman sitting in the exam room and I put the trial frame on her with the stuff and all of a sudden, she said her world stopped moving and she could look at me without feeling the strain and all this other stuff. It wasn’t like a prescription like you’d normally find. It’s often the thing that we were taught to dismiss in school. It’d be like, “Whatever.” She broke into tears, and so did I. It’s hard not to when somebody’s feeling that and you’re highly empathic. It hits you pretty hard. I’ve had a number of those. It’s funny with kids. You’ve got young kids. If you remember when you’re a child, you don’t remember much past a few days before. Your time window of consideration is so small.
Kids don’t often reference as much stuff themselves, but when you watch their confidence grow, they can read the same way their peers can, or they’re doing well or they see themselves learning and they see themselves like that. You watch how differently they start interacting with the world and how they carry themselves and all these things. That’s probably one of the other meaningful ones.
Another one was an 80-year-old patient of mine whose progressive lenses were changed to consider depth and spatial perception, even a tiny bit of vision therapy based around depth and spatial stuff. All of a sudden, she could do stairs again. She wasn’t falling in her house all the time. Her level of independence had improved massively. She’s no longer bumping her car into most things. She doesn’t have to drive by feel. Yeah, there’s a number of those things that hit you. I joke with my patients. I’m like, “If I won the watery, I would still do my job. I would just not have to worry about a mortgage.”
That’s special on its own, to find somebody who loves what they do. I ask people this often, “What would you do if you didn’t have to worry about getting paid?” If you choose to do the same thing that you’re doing now, that’s pretty amazing that you get to do that day in, day out. That’s special. To help people in those positions, that’s profound. You’re saying they’re actually planning their suicide.
That’s the difference between thoughts. You’ve talked to enough mental health providers. It’s the plan that indicates how serious things are.
It’s amazing that you’re doing that and able to help even one person in that position. That’s profound. You’ve had a few of them. Amazing. Fortunately, I haven’t had the experience of patients who are considering suicide. Going back to the part on helping children. On the children’s side of things, there have been numerous kids throughout the years who I’ve seen progress and improve. That’s rewarding to see as well. One of the things that you and I talked about was kids who come in 3, 4 years old and they’re practically nonverbal. They’re behind in their speech development and you see they need glasses. In some cases, a very simple prescription. In others, maybe there’s a bit more going on.
When you prescribe that and six months later, a year later, they’re almost caught up to where they should be. It was the simple act of bringing them in for the eye exam that kickstarted that whole process. Parents can see it, too. One of the things I say to a lot of patients and to parents in serious situations like that is, “If the visual system’s not functioning right, it’s draining so much energy from the rest of the brain that other parts of the brain can’t work the way they’re supposed to.” You’ve done something that actually shows this. I’d love to hear a little bit about what you’ve done to test it out to prove that theory.
The EEG. I think you’re totally right. I use the same explanation with people a lot of the time. Vision, 70% of the sensory information coming into your brain and over half of your brain’s involved in using it. If it’s not working efficiently, it’s hard to do other things. It’s one of the reasons a lot of people have poor reading retention. If their brain’s having to put so much cognitive, so many cognitive resources into the simple eye movements themselves, there’s less of a channel. There’s less attention. Less cognitive resources are available for paying attention to and understanding and retaining what we’re reading. One of the things that we’ve looked at, which came up in an interesting way a number of years back, is there’s a little test called pattern glare.
It’s like high-contrast black-and-white lines. We’d often use that with people to see if they’re visually sensitive. If you want to tell if someone’s headaches or migraines are due to their vision, show them pattern glare, the black and white lines. If that makes somebody feel like it’s going to give them a headache or a migraine, then what do we know? Vision’s one of their triggers. If you have allergic reactions and we go, “Herbie, we want to see if you’re allergic to peanuts.” We give you a peanut and you swell up and then we’re like, “It doesn’t mean it’s the only thing you’re allergic to, but we definitely know it’s one.” The same is true of the pattern glare and black and white lights.
I don’t think that test would fly these days, though. You’d have to be a little careful about that.
Instead, they do the little cuts in the arm with little things so it doesn’t blow it all up. What was neat with the pattern glare is if you change somebody’s glasses or lenses to provide the most stable binocular vision, you would actually see that they would have a subjective change to their response to the pattern glare. They’d go all of a sudden, “Those black and white lines don’t bother me as much anymore. Cool. I can look at them or it’s not as aggressive,” or, “It still bugs me, but it’s not as bad.”
We found that if you hook them up to an EEG and watch what their brain is doing, you will see an objective change on the EEG that correlates to the subjective change. You’re actually watching changes in how the brain’s processing the visual information based on the stability of the binocular system, again, correlated to their subjective experience. That is nice because when you’re involved in a lot of medical and legal stuff and whatever, the objective experience is thrown out to some degree, which is hard.
You’re watching changes in how the brains processing the visual information based on the stability of the binocular system correlated to their subjective experience.
That’s pretty cool that you’ve done that and nice to know that there is that relationship there. It’s again bringing credibility to the theory that I’m sharing with my patients. Now I can go back and can speak to my patients a little more.
You were already on top of it. You needed me to come in and be like, “Yeah, you’re right.”
I appreciate it. Yes, it’s nice to have an expert come and verify some of these things that I was doing on a bit of intuition there. I’m glad I was on the right track. I want to learn more from you, Cam, and you are going to provide an opportunity for someone like me to learn more from you. I’d love for you to share a bit more about what’s coming down the pike and what to look out for. If someone like me who does very little or no binocular vision VT-type stuff wants to start getting into it, we can start learning that way and optimize our practice.
A lot of this comes from my natural self and then my journey through this. One of the things I realized very quickly is that, and a lot of people will, if you have interest in getting into the vision therapy side of things, even if it’s more effectively prescribing lenses and glasses for certain stuff or whether it’s like full blown you want to do therapy, it’s hard. There’s multiple different educational bodies. They all ha are siloed and do things a little differently. In my education, especially in the beginning, I realized pretty quickly that one of the downsides of some of these silos was that people would be very into their way of doing things and not always recognizing the benefits of some of the other VT stuff that was out there or even aware of your own holes within some of the theory and stuff.
My goal over the years has been to piece things together from all the places that I could and then systemize things. I’m a systems guy for stuff. It’s funny, when I trained my associate, I think his idea of what VT would be like and what it was like in the exam room was very different from how we actually run it at the office. My new patient visits are like 20 minutes of pretesting and then 40 minutes with me. At our school, it was like a three-hour long appointment with all this stuff, angle A and angle S, and all these things. There’s a lot of that stuff that a lot of the time doesn’t actually matter that much. Is it actually going to change what you’re going to do and your outcome?
My goal has been to boil these things down into such a sense that we can empower people to make a lot of change for patients without necessarily having to run a full-blown VT practice or without having to do all of these things. How do we bring even 80% of that knowledge to the primary care optometrist who may want to get more interest in that area? Coming up, we’ve got some courses that’ll be coming at different levels and layers of that to allow people to integrate a lot of that knowledge into their exam.
How great would it be if you’re doing your exam with somebody and, pretty quickly, you know how to manipulate a progressive lens prescription so that they don’t reject it so it actually enhances their depth perception as opposed to not? It doesn’t have to ruin the flow of your exam. There are little things that can be done. Some of them are so simple. This is a non-optical one.
One other thing you might not know about me, I don’t know if I shared it when we talked, but I spent a few months living in Whistler actually taking courses in language and the study of Neuro-Linguistic Programming stuff. At the beginning of every exam, I ask people two questions, which is a great take-home for the readers. I ask them two questions. I say, “One, before we begin today’s exam,” which takes the pressure off because we’re not beginning, “As we go through history, is it okay if I interrupt you sometimes so I can dig deeper in certain places?” No patient is going to say no to that.
They go, “Yes.” You now have permission to interrupt somebody where you need to and they are happy about it. As they’re going through their history, you can interrupt to dig deeper in spots and it’s not awkward. Everybody’s happy. You can keep things on track and get what you need because there’s nothing worse than sitting there and having somebody spill a bit of everything. They’re giving you what they think is helpful info, but it’s not. You’re afraid to interrupt.
The second question that I ask all my patients is, “What would you like out of today’s appointment? What would make today good for you?” It’s not what the chief complaint is because so much of the time, you’ll have people sitting there and they’ll say, “My wife told me to come.” Whatever they tell you, you now have the criteria for making the day good for them. They’ve literally told you what needs to happen for them to be happy with their experience. That changed a lot for me because otherwise, I was sitting there assuming or projecting what I thought they wanted out of it. Those two things completely changed it.
It seems like almost, for me, both of them would be slightly awkward questions, but I guess once you get comfortable asking them, it’s fine.
The only awkward part is how you feel about asking it. It felt like that in the beginning. You approach it like they’re the natural questions to ask. I’ve had so many other healthcare providers as patients who’ve been like, “Can I steal those? I’m going to use those.” I’ve had so many patients be like, “Nobody ever asks that of me. They ask me what my symptoms are and then the doctor does their thing and tells me what I need to do,” without often taking into account what does that person actually care about and want. There’s a big difference between somebody wanting a diagnosis and treatment. There’s a big difference between somebody who wants to feel better about having a condition or maybe they’re super worried about it and they need some peace of mind.
It’s so funny you said that because right before that, I thought you’re right because sometimes, people want to know that they’re okay and don’t have glaucoma. “My mom had glaucoma and I want to make sure I don’t have it.” That’s what they want to get out of the exam. We start saying all these other things and then at the end, they’ll be like, “Yeah, so what about the glaucoma?” They don’t have it, so you don’t think to say it, but that was the thing that they wanted to make sure they didn’t have. That was the thing they wanted.
You nailed it. We’d have a tendency to brush it off. We’d be like, “Of course, you don’t have glaucoma,” whereas if you’ve asked that in the beginning, instead of spending five minutes talking about X, Y, or Z, you can actually spend five minutes showing them their OCT and making them feel confident and comfortable on how you’re going to monitor that each year for them. You’ve spoken into their listening about what they want to know.
Instead of spending five minutes talking about X, Y, or Z. Spend five minutes showing them their OCT and making them feel confident and comfortable, and how you will monitor that each year for them.
Asking what it is the patient would like to get out of the exam.
The key question there is also, “What would make it good for you? What would you like out of today’s appointment?”
It’s a two-part question, you could say. The other question is, “As we go through the exam, can I interrupt you? Would it be okay if I interrupted you to go a little deeper to learn a little bit more?”
“As we go through your history, is it okay if I interrupt you sometimes to dig a little deeper?” Everybody will end up with their own version of it. Essentially, again, you’ve gotten their permission for it and they’re happy about it. You’ve totally reframed interrupting someone.
It definitely put a positive spin on that because you’re interrupting to learn more. You’re interrupting to provide a better outcome, not just because you’re rude and you don’t want them to keep talking.
Otherwise, that’s what people assume. People assume you’re trying to rush them instead of being like, “No, that’s an interesting point. I want to dig deeper here.”
Cam, there are two questions I ask everybody at the end of each episode, but before we get into that, here’s a chance if you can share some information of how people can get ahold of you, learn more about you, where would you like people to go?
Opto-Mization.com is our website. If you Google Cameron McCrodan, there are not many of us out there, so it pops up pretty quickly. I don’t know if we have a link on the site yet for registration for some of the course material we’re going to be putting out there for people. My mission in life is actually to change how we deal with vision in general. That involves using a lot of the stuff that we’ve learned, even within the context of primary care optometry, which will make it more meaningful and better for primary care ods and better for all the patients, too.
How do we distill down these simple things that actually work that can be done in that? I’ll send out a thing for you through for your readers once we have some registration stuff for it. For right now, people can learn more through the website. You can always send us an email if you want because we will keep a list of emails for registration for that stuff, too, because I’ll tell you, it’s been an absolute game changer.
What I’d like to do is I’m going to take your course or courses and then we will have you back on after I’ve done it and you can test me, see how much I’ve learned.
You know what I think the fun part will be is that I think it’s not even a question. It’s not meant to be one of those things where it’s learning in terms of testing for stuff like that. I look at it like going, “Are there ways that we can enhance the process?” Even on the simple act of prescribing, are there ways that we can improve how we actually prescribe the lenses and even how the lenses are dispensed to better the outcome for the ods and the patients for that too? That’s going to be the core concept of it. Can we distill down a lot of the meaningful things that I’ve learned in the last 20,000 hours of doing this and implement those things into primary care practice in a way that makes it more meaningful and better return for the docs and better outcomes for the patients, too?
One of the concerns these days is the commoditization of what we do is optometrists and the concern that will become refractionists for some large organization. If you choose a certain path in the profession, that is going to be your career, unfortunately, if that’s a choice that you make. If the rest of us want to thrive and we want our profession to thrive in the long-term, it’s doing stuff like this as it’s going to help us do it. It’s not spinning the wheels and selling a pair of glasses. It’s providing a service that’s above and beyond. It’s helping solve problems that other places can’t solve. It’s implementing these types of specialties into our practice.
I highly encourage anybody out there who’s even a little bit interested in doing a bit of VT, keep an eye out for this. I’m definitely going to do it myself and I’m going to report back. I look forward to that. There are two questions as I said that I ask everybody at the end of the show. Number one is, if we could hop in a time machine and go back to a point in your life where you were struggling and having a hard time, if you’re comfortable, you are welcome to share what that moment was. More importantly, what advice would you give young Cameron at that time?
I’d say there’s three. It comes back to one of my favorite sayings. One, two most important days in your life, one being the day you’re born and two the day you figure out why. I’d say the third one is when you realize how your unique combination of experiences, challenges, triumphs and character traits puts you in a position to do things that are a unique strength of yours. I think this is important for a lot of optometrists, too, because both through school and through our colleges and everything, we’re taught that an optometrist is an optometrist and everybody thinks the same. I hated that at times when I was first out practicing and you brought it up in terms of the refraction piece.
What I’d go back to say to myself and what I found so powerful within that is none of us are actually optometrists, whether it’s outside hobbies and things we enjoy and love or parts about our personalities or parts about what got us to optometry in the first place or other experiences we’ve had. Once we realize how we can pull from and integrate those other parts of ourselves that bring a unique part of us to that and how we can utilize that in the context of our practice, I think then work becomes way more fulfilling. It’s funny that you mentioned refraction. I’m going on a tangent, but I’ll keep this under a minute. I used to hate refractions because it was like I was basically doing an autorefractor thing. Anybody can do this for you.
When I started being able to approach refractions in the sense of going, “How do we optimally help your depth perception work? How do we give you better reading? How do we reduce your headaches and migraines at the computer?” You’re thinking about that during the refraction, all of a sudden, the refraction actually became an incredibly powerful agent for change for a person and became way more enjoyable and fun.
Not only that, but then, I never even had a glasses dispensary in my office because I hated the commoditization of glasses and I hated the image of that until I realized that so many places, both expensive and inexpensive, don’t pay attention to some of the things around making glasses that make the difference between how amazing they work or how they don’t. All of a sudden, having a dispensary was actually one of the most ethical things that I could do for my patients.
By the way, we have a satisfaction guarantee on all our glasses. If they don’t love them, they can return them for a refund. We do all sorts of things that make it seem like the most ethical thing we can do for them, but it also means that the prescriptions we give people are actually what they end up looking through. Ocs aren’t messed up. Prism centers and pals aren’t doing weird things. I think that that is the piece in a nutshell that is coming back to what are the things that uniquely make you you, the traits that you have, the experiences that you have and then how do you integrate that into your mission and your skillset and what you can do in life. You then feel like you have something as opposed to kind being another dial spinner or whatever.
The last question that I ask is, everything you’ve accomplished to this point, how much of it would you say is due to luck and how much is hard work?
I don’t think you can actually fully tease those things apart. You’re familiar with our reticular activating formation. All of you reading this who’ve thought of buying a new car, and you’ve probably heard this before, the minute you’ve thought about buying that car, how many of those cars do you see everywhere when you drive around? All of a sudden, do more people have those cars? Absolutely not. Your brain can only process so much info. Once you’ve set an intention and once you’re aware of it, you’re more aware of what’s there.
What I say is that a big part of luck, a lot of the time, is also being able to spot the opportunity amidst the sea of other things. There’s a huge component to being present to spot the opportunity, but also to be able to take risk and go with that and work hard through that. You’ll see a lot of people who work hard but they can’t do those parts. You’ll see people who are lucky, but they actually never seize the things that are there. I think I’ve had a wonderful combination of the two things over the years. A lot of things are luck that don’t look like luck at first.
In the old farmer’s parable, the farmer loses his horse and all his neighbors are like, “That’s so bad. That’s such bad luck. You lost your horse.” The farmer’s like, “Good or bad, I don’t know.” The horse returned the next day, and it brought with it a wild horse. It’s got a second horse and his neighbors are like, “That’s amazing. That’s such good luck. Now you have two horses.” The farmer’s like, “Good or bad. I don’t know,” because then his son breaks his leg trying to tame the wild horse.
I’m not going to go through the whole thing, but it goes on like that. For the most part, our judgments of what’s good or what’s bad or what’s lucky or what’s unlucky are sometimes only in the context of what we can see in that immediate time as opposed to how it plays into the bigger picture, which a lot of the time depends on what do we do with it when it’s there. Are we a victim of circumstances or do we figure out, given this, how to proceed?
Our judgments of what’s good or bad, or what’s lucky or unlucky, are sometimes only in the context of what we can see in that immediate time as opposed to how it plays into the bigger picture.
Actually, when you started reciting that, I realized I had heard that before, but that’s a good story to keep in mind. The question of course, is intended to create a bit of a dialogue because it’s hard, but some people do. They’ll say 90% hard work, done. All right, great. Maybe that’s what it is, but sometimes we don’t realize that there’s luck involved. We don’t perceive it as luck at the time. If we look back, maybe in hindsight, we start to see how lucky we were.
I appreciate that. Thank you, Cam. I appreciate the answer. Thanks for sharing everything that you have. I want to have you back on because we need to start talking a bit more. As I told you before, I don’t do a lot of clinical-type conversations and this one wasn’t at all because this was a lot more about how we need to think about VT and how we can change the profession in our practices. I think we need to do a bit more of a clinical conversation where you can talk about some how-tos, how to fix this problem, how to solve this issue. We’ll have you back for that. I want to do that course and we’ll see how that goes as well for my practice and it’d be fun. Any final words you want to say?
It’d be fun at some point to get into some of the more contentious topics, too, because those are the things that I love digging through on the logic side of it as well. I’m more than happy to do that.
I want to get angry emails from people in VT.
You know you’re doing it right if you get angry emails from people on both sides of the coin. You know then that you got it. Last words, what I’d say is for anybody out there who’s reading, if you’re in the Victoria, Vancouver Island area, always feel free to give us a buzz and come check out the office. I’d be more than happy to show people around or I’d encourage them in their local area. If they’re co-managing with VT ods, get to know them. Go check out how they approach things because it will be different depending on the person and you’ll find somebody whom you mesh well with and the practice works well and it can be a symbiotic relationship.
That’s actually a great idea. Actually, that’s another one of the points I like to make when it comes to strengthening our profession. It’s working with each other. OD to OD referrals and connections like that is what’s going to help strengthen our profession versus ignoring the problem. Let me go on a bit of a tangent. When we ignore a problem, somebody else is going to come and fill the gap, so to speak there.
That’s not always going to be an entity that we want to be there to fill that gap. With our relationships amongst one another, we need to fill those gaps, but it helps provide a better perception to the patient, too. “My primary care OD knows what he’s doing because he or she sent me to a specialist in the area who knows what they’re doing and I got a good experience.” I go back to my primary care OD and I’m happy with that whole relationship versus something not happening to that effect. That’s going to help us build our entire profession in the long-term. I like that little point that you’ve made as well. Thanks again, Cam. I appreciate your time, and I look forward to having you back again. Thank you to everybody who’s reading. Thank you for reading and I look forward to seeing you guys in the next episode.
