03 Seeing 20/20 Is Not Enough - a podcast by The InBound Podcasting Network

In this episode you will learn why seeing 20/20 is simply not enough. Douglas W. Stephey, O.D., M.S. will explain how the three circle Venn diagram of vision will most likely show that your last eye exam may have come up short to enable you to move, look, and listen through your life with ease.

Douglas W. Stephey, O.D., M.S.

208 West Badillo St. Covina, CA 91723

Phone: 626-332-4510

Website: http://bit.ly/DouglasWStepheyWebsite

Videos:   http://bit.ly/DrStepheyOptometryVideos

The Move Look & Listen Podcast is brought to you in part, by Audible - get a FREE audiobook download and 30-day free trial at www.audibletrial.com/InBound

If interested in producing a podcast of your own, like the Move Look & Listen Podcast, contact Tim Edwards at tim@InBoundPodcasting.com or visit www.InBoundPodcasting.com

Transcription Below:

Tim Edwards: The Move Look & Listen Podcast with Dr. Doug Stephey is brought to you by audible. Get a free audio book download and a 30 day free trial audible membership at audibletrial.com/inbound. You'll find over 180,000 titles to choose from, including several books mentioned here in the podcast. Support the Move Look & Listen Podcast by visiting audibletrial.com/inbound. 

Dr. Stephey: If our two eyes are not working together well as a fast synchronized team, our internal mapquest continues to be off. It's consistently inconsistent with our ability to judge time and space. Those that don't feel well-grounded, those that have some measure of anxiety, oftentimes it starts in the visual system. If you can't move, look and listen in a fast, accurate, effortless, sustainable, age appropriate, meaningful way, you're in a world of hurt. There's a whole world in vision and how it affects brain function that no one's ever shared with you. 20/20 is perceived as a holy grail of going to the eye doctor. Well, I'm here to change that paradigm. 

Tim Edwards: This is episode three of the Move Look & Listen podcast with Dr. Stephey. I'm Tim Edwards with the Inbound Podcasting Network. Happy to have Dr. Stephey with us here in our roster of shows as we move forward in the Move Look & Listen podcast. Dr. Stephey, we've talked about common eye problems in our last episode and now you alluded to this topic in our last episode and this is I think something that's quite interesting and I think might raise an eyebrow or two of somebody listening on the other side of the speakers. 20/20 is not enough. You've said that from the first day that I've met you and I've known you a couple of years now. 20/20 is not enough. `We've been told our whole lives. Oh you've got perfect vision. You could see 20/20. Not the case apparently. 

Dr. Stephey: That is not the case. That's right. 20/20 is presented as a holy grail of going to the optometrist and it is. I'm here to tell you it is a tiny piece of the puzzle. It's an important piece because clarity of vision is a big deal, right? But it's only a piece. So for example, picture three circle venn diagram. 

Tim Edwards: Okay. 

Dr. Stephey: And one circle is can you see 20/20. One circle is related to eye health. Make sure you don't have dry eye or glaucoma or macular degeneration or bleeding in the eye if you're diabetic or any untold number of eye health issues. That's circle two. Circle one and circle two is where most eye doctors practice. They do have a place for sure and they do have value, but there's the third circle that oftentimes is missing. And within that third circle there's pieces like, eye taming, eye focusing, eye tracking. There's components related to visual-auditory integration, visual-cognitive skills, visual-spatial skills, visual attention, visual processing speed, magnocellular vision or motion processing, visual vestibular or vision and inner ear integration issues. 

Dr. Stephey: There's a lot of stuff going on in that third circle. And my experience over the years is that if you don't do vision therapy in your practice, you tend to ignore that third circle. I went to a lunch meeting a number of years ago at a local credit union. They did lunch meetings for their employees. They invited me to come as a speaker and I talked about this specific topic. And I was talking about eye taming, eye focusing and eye tracking. And that if you didn't have those skills, you might get sleepy or tired when you read, you might get headaches when you read, you might get motion sickness when you're riding in the car. You might have to be the driver because if you don't, you get dizzy or motion sick that you're ridiculously clumsy. Can't play sports that include catching a ball or throwing a ball accurately, and one of one of the attendees, they were sitting in the back. They raise their hand and they said, hey, so what kind of questions do I need to tell my eye doctor the next time I have an eye exam? And I said, if you have to tell your doctor what kind of questions he should be asking you, you're going to the wrong eye doctor. 

Tim Edwards: Absolutely. Well, what you just said that you really mentioned a good portion of the population there, Dr. Stephey with all of those things that people might be suffering from. 

Dr. Stephey: Tim, the list is ridiculous. Right, so just a quick review. Headaches, migraines, motion sickness, ADHD, autism, dyslexia, learning disorder, clumsiness, can't play sports, uncoordinated. It goes on and on. 

Tim Edwards: And all of those sit inside that third circle. 

Dr. Stephey: They really sit inside that third circle. 

Tim Edwards: And you said a minute ago that most optometrists disregard that circle or don't even acknowledge that it exists. So what do you do in your practice that's different so that you can help people that are suffering from this? 

Dr. Stephey: Well, there's another story to tell you. I was at a meeting long, long time ago, probably more than 20 years ago. I used to be involved in with our state association politically before my first daughter was born. And when I would meet people around the state, I might ask the question, hey, remember when we were in optometry school? 

Dr. Stephey: What was the percentage of patients that were thought to have vision therapy related problems? And all most to a doctor, they'd always come up with 10 to 20 percent. 

Tim Edwards: Seems rather small. 

Dr. Stephey: Well, if we look at the population at that's probably not unreasonable. The prevalence of those problems go way up almost to everybody. If you have any of those diagnoses I mentioned a minute ago. But population at large, I say, okay, I'll give you the 10 to 20 percent. So let's say that you do 10 exams a day and you work five days a week, so you're seeing 50 patients a week. So you're telling me that you're talking to five to 10 patients a week about vision therapy. And then that's when things get quiet. And the eyes get big as saucers because they're running a movie in their head about when's the last time I talked about vision therapy to anybody? 

Tim Edwards: Now do they not because they don't know enough about it? Or did they not because they don't have time to take on the case load? Or and or should they because there's actually more revenue to be generated? 

Dr. Stephey: Well, this has been my impression. It's not because they don't have the training because we all get this training when we go to optometry school. So it's not that. Their go to answer historically was, well, Doug, I don't really see patients like that in my practice. And my typical answer was I believe that you don't see them. It doesn't mean they're not there. 

Tim Edwards: Well put. 

Dr. Stephey: So I think there was truth in their statement. They don't see them and the reason they don't see them is because they don't ask the same kind of questions that I ask and they don't do the kind of testing that's going to reveal those kinds of problems. 

Tim Edwards: It's true. And what's fun to watch is because I've had a front row seat, not only to be the one that you were asking those questions too, but I, I recently brought my wife and to meet with you to fix an ailment she's been suffering from. 

Tim Edwards: And the look on her face as you were asking some of these questions was hilarious to me. Because these are not questions that one normally gets asked when they're sitting in the chair at the optometrist office. 

Dr. Stephey: No, you never get asked these questions. You dig deep. 

Tim Edwards: And you find solutions by digging deep. 

Dr. Stephey: You know, one of the things that I thought for a long time about what sets my practice apart from most is that whenever I have an encounter, I'm going to presume you have one of these problems until I asked you enough questions or do enough testing to prove to me that you don't. 

Tim Edwards: To omit it. Gotcha. 

Dr. Stephey: That is a completely different mindset. Because I've had patients come where they have complained about a lot of the questions I'm going to ultimately ask of them and discuss. They've brought up these issues with many of their past exams and then get shined on so that's even more egregious. 

Dr. Stephey: If he never asked the questions and the doctor doesn't find your problem, that's one thing. But if you're actually complaining about stuff and your needs still go unaddressed, that's just wrong. And I can't practice that way. I'll give you a good example. I got a phone call from a medical group yesterday who was calling me to work out a contract to provide vision therapy to a mutual patient of ours. This gal has an HMO that I'm not contracted with. I wrote her a treatment letter. It's been a long fought battle. It's been, I kid you not probably nine months since she started this trial with her medical group and her parent insurance company. Around and around they go. Well, somebody from the medical group calls me yesterday and she said, I've never heard of medical insurance paying for vision therapy. Okay, well, I don't know what to tell you. 

Dr. Stephey: And then she said, well, one of my kids did vision therapy years ago and I paid for it out of pocket. Well, maybe your eye doctor should have had this conversation with you and been a better advocate for you. And then I said, by any chance, did that child have an IEP or a 504 plan at school? And she said, well they had a 504 plan and I said, well your optometrist should have told you that vision therapy is should have been funded by your school district as well. And they didn't tell you that either. And that's going to be one of the upcoming episodes that we do where we really dig deep into special education regulations and what these kids are not getting and how to be a better advocate for your child and really go out and fight for their educational rights because there's a lot of them. 

Dr. Stephey: And we're going to spend at least one episode really drilling that down so that you'll be much more knowledgeable about how to go fight for your kids' rights. So then when this gal's on the phone with me, and I know now that she's got a child who's got a history of needing vision therapy, well I started to ask her some of my standard questions. Do you get sleepy and tired when you read? Does overhead fluorescent lights bother you when one of the bulbs starts to flicker? Does are you bothered by bright sign, light and glare. And of course she starts answering yes to all my questions and so we really kind of finished the conversation and she said, you know what I need to, I've been putting off making an appointment. 

Tim Edwards: And that's not the reason she was talking to you in the first place?

Dr. Stephey: No, heavens no. So she made an appointment to come and see me before we got off the phone. 

Tim Edwards: I love it. 

Dr. Stephey: So and I did the same thing. I went back to Illinois to visit family back in November and went up to the local small town bank that I grew up in and the person who's working with us at the bank, I start to ask him some of the same questions and sure enough he's got problems with the way his two eyes work together. So it doesn't make a difference who I'm meeting, where I'm meeting them. If it lends itself to have this conversation, we'll start to have it and I'm never surprised anymore about really how commonplace these problems are and nobody's finding out. Hopefully you begin to understand that 20/20 in fact is not enough and there's that third circle in the venn diagram that holds a whole bunch of magic in that third circle and those are about diagnosis. So you can't have a treatment option or you can't have a treatment plan if you don't have a good diagnosis. So we've got to dig deep into the third circle and do the kind of testing that's required to determine what's really happening and then once we know that information, we can come up with a treatment plan and how we're going to manage these things.  

Dr. Stephey: And there's short term goals and there's long term goals. Short term goal for me is I want to improve your quality of life. If you get migraine headaches, I want you to have them less or to get rid of them altogether. If you're motion sick and you limit your travel because how sick you get driving in the car, well then I want to make a short term goal. What you do to be able to drive in the car, go to the local mountains, whatever, go to the amusement park, ride in the tea cups at Disneyland, whatever. Whatever it takes. 

Tim Edwards: Those days are done. I can check that box or I need to go see you. We just got back from a Disney world vacation and just looking at the tea cups made me a little queasy, so.. 

Dr. Stephey: That's a magnocellular vision problem, Tim. 

Tim Edwards: Let's fix it then. So I'm going to tea cups again with my kids. 

Dr. Stephey: So short term goals are about improving your quality of life. How do we go about doing that? Well, I go about doing that primarily by being sensitive to your prescription needs, not just the conventional farsighted nearsighted astigmatism. One thing I've learned over the years is that there are many patients who are super sensitive to the tiniest amount of change. And because there's a tremendous amount of our brain space, if you will, that's allocated towards vision and vision processing. I might make the tiniest change in your prescription and you think I can walk on water because of how much better it feels. So we normally prescribe lenses in quarter diopter units, right? We go from a minus a quarter to a minus a half to minus three quarters to minus one, so on. But if you're really sensitive to what I'm alluding to, I might refract you down to an eighth of a diopter. 

Dr. Stephey: So it's a point one, two power change. And I've had a number of patients over the years where I make an eighth of a diopter change, in one or both lenses, and it immediately changes their quality of life. Their entire perception changes. 

Tim Edwards: Can you do that with contacts as well? Or are they all just made in quarter increments? 

Dr. Stephey: You cannot get an eighth of adopter in a contact lens as far as I know. In a soft lens you can get an eighth of a diopter, I believe in a hard lens. Yep. So the first is be sensitive to the patient's prescription. Sometimes it's being sensitive to the frame that they were wearing. So one of the things that I do in my exam room, I've got two black clips that are,  like a black plastic ring that is about maybe an inch and three quarters in diameter and I can clip them over your glasses and what I will oftentimes do is have patients look at my standard eye chart, I sneak these two little black clips out of my drawer and put them over your glasses and ask you to tell me how my art shot looks and how it feels.  And namely is it clearer and is it calmer? 

Tim Edwards: And that's the difference. How it feels. 

Dr. Stephey: Yes. Because oftentimes people will pull back away from my black rings and they'll say what? I'm like, I want to know if it's clearer, but I'm also interested in whether it feels calmer. And so now they've got a new context of what to pay attention to because nobody's ever asked them how it feels to see just how clear is it to see. 

Tim Edwards: Now explain that. There might be our friends on the other side of the speakers that are saying or thinking, what do you mean? How it feels to see? 

Dr. Stephey: Well, if you have a problem with motion processing or binocular vision or visual vestibular or visual inner ear integration issues, you don't feel calm when you see. 

Tim Edwards: You mentioned going on like some anxiety associated with it. 

Dr. Stephey: Yes, and that's going to be in one of the next episodes where we talk about the polyvagal theory of affect, emotion, self regulation and communication. And that's going to be a really fun episode to do because it's one of my favorite topics to talk about. 

Tim Edwards: Absolutely. 

Dr. Stephey: So when we look around every day and every waking second of every day, it ties into us subconsciously asking ourselves the question, do I feel safe? Well, if you look around and can't answer that question, then you're not going to feel safe and you're more likely to be highly distractable, highly anxious, highly fearful, and that does not feel calm. If you're in a perpetual state of fight or flight, that does not feel calm. But because nobody's ever asked you that question before, if you have those kinds of experiences, you don't even know that there could be a vision component to those experiences. 

Tim Edwards: So let's simplify that a little bit because you said, does one feel safe when they look around. Now that goes back to our primitive days, right? It's primal in terms of feeling safe and you're not talking about if you're in a good or bad neighborhood. You're talking about and how you're processing the information that you can see. 

Dr. Stephey: I'm talking about you roll out of bed in the morning in your own home and your brain is looking around and asking itself the question, do I feel safe? And an example of that would be if you have a TV in your bedroom and if you've ever noticed if the room lights are dark and you stand off to the side, the TV images that are generated, it really has a strobe like effect. There's a great deal of flicker involved with the changing of that imagery. Well, if you're the kind of patient I'm talking about, you don't like flicker. You don't like flicker, you don't like bright sunlight and glare. You don't like movement in your periphery and you don't like regular repeating patterns. Certain stripes, checkerboards, plaids, polka dots, certain patterns really, really bother you. 

Tim Edwards: And that's where one might not feel safe because they bother them. Those things that you're talking about, they're troublesome. 

Dr. Stephey: It is troublesome, so it's like a neon sign flashing in your brain that says, look here, look here, look here, look here, look here, and like a tractor beam. You can't help but look, but you're more miserable when you do so. It's like the proverbial moth to the flame. One of the other questions that I love asking and when I get this as a yes answer, it really makes my day. Because one of the questions I'll ask people is, hey, when you drive in the carpool lane and the concrete dividers whiz past your peripheral vision, does that bother you? Well, I can't tell you how many people. When I say when you drive in the carpool lane, I don't do that. 

Tim Edwards: Yeah, because that's right. They can stop you right there. It bothers me. Right. 

Dr. Stephey: Yes. Here's my favorite part of that question and that's what I followed up and I say, okay, so has it ever felt like your car was and going to drive itself into the wall and that's when I look at me like how could you possibly know that will. That is a perfect example of whether one feels safe or not with the information they're eyes are bringing into their brain. Yes. And, and, and for those people that say that's exactly how I feel. Yes. It feels like the car's going to drive itself into the wall. Like how could you possibly. I know that and then I, then we have a chuckle about it because I say I'm pretty sure nobody else has ever asked you that question and I'm pretty convinced you've never offered it up as a symptom because people would think you were crazy. Yeah. 

Dr. Stephey: But when you, when you don't see fast and you've got that movement in your periphery, zinging along in the periphery, it again, it's like a tractor beam to your attention. Your attention goes that way. Your eyes go that way. Your head wants to turn that way and when your hands are on the steering wheel, when you physically want to turn your head and look to the left, sometimes your arms want to move in the direction of your head turns and there goes the steering wheel and the car is going to want to drive itself right into the wall and those are the folks that are, even if they don't avoid the carpool lane, they white knuckle it the whole time they're in there, they break out in a cold sweat. They tell everybody in the car, don't talk to me right now. I'm concentrating. They turn off the radio and they break out in a cold sweat because they're exhausted when they get to where they're going. 

Tim Edwards: Now that's just one example. There are many things, like you said, that people go throughout their day. That's just an obvious example, but little things throughout the day that trouble people, they might not even know that it's troubling them until you put that clip back to your exam again. 

Dr. Stephey: Yeah, so we put the black clips on and oftentimes they will tell me. Well, yes, it's clear and calmer. I really liked these lenses. And then I take my black clips back that have no lenses in them and I stick my finger through the empty black hole and then they look at me like, what? What just happened? Like how, no, wait a minute, how did that work? And I say like, are you tricking me? I'm like, I didn't. No, I'm not tricking you. I didn't try to talk you into telling you who was going to be better. I just asked the question, you tell me is it clearer, calmer when I do this? And then of course when you have that experience, you immediately want to look again to see if you get the same effect. So I tell you that example because one, it's a great opportunity to discuss that 20/20 is not enough and that there's a whole lot more going on that people didn't know about. It may also tie in to when we go out front and talk to one of my staff about the kind of frame I'm going to tell that patient to pick out because I might tell that patient, you know you need to get a frame that's got a full wire, a full plastic rim to it. 

Dr. Stephey: Don't get a rimless frame, don't get a thin wire frame. I want you to get a thicker frame with thicker temples and thicker eye wire because we want to use that frame like the black rings that you just told me are clearer and calmer. And sometimes the black rings don't really make a difference and that's okay. Because then we'll continue on with some other testing strategies to then compare their outcomes with their standard prescription or if I add color or prism over the top of their glasses prescription. I have a variety of ways that we're going to determine that outcome. And one of the outcomes that I love when it works, it is powerful. I will have those patients sit in my exam chair, look up at one of my overhead fluorescent lights and ask them to simply breathe, take two or three deep breaths, and they do and I watched their chest and abdomen when they do that and get an idea if that's easier, effortful, then I'll give them prism or color or some combination of things and have them do it again. And I can't tell you how many people take the glasses back down and look at me and say, how does this possibly work? Because that is remarkably easier for me to breathe. 

Tim Edwards: Now let's tell our friends on the other side of the speaker again, that these are lenses that have, could have a little bit of color tint to them. 

Dr. Stephey: These are lenses that could have a little color tint and I've got a whole briefcase of colors in my office. I've got about 50 pair of lenses, a variety of different colors, different shading of each of the colors. Most people that I do this with and most of the research that I've read over the last 15 or more years, blue itself is a very calming color. So if you have a nervous system, if you're prone to anxiety, if you're prone to motion sickness, if you're prone to headaches, if you're prone to high distractability, you've got a nervous system that is functionally hypersensitive, and if you're one of those patients you don't like bright colors. 

Dr. Stephey: You don't like looking through bright colors. You don't like looking at bright colors. You don't want bright colors in your house at home. You're not going to typically wear bright colored clothing because yellows and reds and oranges take a hypersensitive nervous system and make it even more hypersensitive. 

Tim Edwards: Which gives somebody a sense of anxiety.

Dr. Stephey: It does, so that person is going to, their breathing is going to be worse if I have them to look up at my lights, let's say through a yellow, orange or red lens. But the more calming colors, blues, lavenders, sages, those are more calming and it really changes the reading outcomes. And I love talking about that stuff because it's powerful and people get an appreciation that they aren't having an exam like they've had elsewhere. 

Tim Edwards: Well, you say it's powerful and I can just tell you from my own family's experience, when my wife was in there, I mentioned earlier that she's come to see you. And fluorescent light bothers her and so she is a substitute teacher and everyday she's in a different school and the lighting is different at each school and a lot of it is fluorescent if not all of it. 

Tim Edwards: And sometimes they flicker and there are some schools that she will not substitute there anymore because the light bothers her. Well, I haven't told you this yet. So she wears her glasses with a slight blue tint in them everywhere to watch our son play volleyball in the big gyms with a lighting, watching TV at night. But then she tried one school where she stopped going because the light bothered her and it doesn't bother her anymore. So now she doesn't have to limit where she spends her time because it doesn't bother her anymore. All because of that little shift with a slight prescription, I believe in her, glasses as well, but mostly it's that blue tint. She loves them. She looks great. And, it's helped her quite a bit. 

Dr. Stephey: You know, Tim, of course, I always love to hear stories like that and it's exactly why I practiced this way. I can't imagine not practicing this way and I can't imagine how anyone could not practice this way. Because that, those are life changing experiences and they are, they're powerful. And what seems like a little thing, it has given her options to substitute back at any probably variety of schools that where he was limited in their choices before now she doesn't have to. That's powerful stuff. 

Tim Edwards: It is power stuff. And you know, and I said before, Dr. Stephey then, you know, I can say with great authority that the way you practice is very different. Extremely different because, and I'll say it again for those that might not have had the opportunity to listen to episodes one or two. But you know, I have a video production marketing company and I've filmed dozens and dozens of optometrists here in the southern California area where we're recording and none of them, and I mean that none of them compares to what you do Dr. Stephey, which is why you are the one and only optometrist we have here on the Inbound Podcasting Network because you've saying for a long time. 

Tim Edwards: Listen, the world needs to hear this stuff. This is very different. The questions you ask, the way you practice and the enthusiasm of which you speak of how you do this. And I could see the joy in your face when I was telling the story about my wife. It really is astounding. 

Dr. Stephey: Well, and for the people listening to this, you have to understand that when I first met Tim a couple of years ago and we did some videos for my website and we did talk about this stuff and he did say to me, well, you really need to get the word out better. And I said, well, okay, I hear you. I hear you. And then we didn't do anything for awhile, then we did some other videos together and he's like, hey, you really need to do some podcasts. And I said, yeah, okay, I'll, you know, I'll think about it. 

Dr. Stephey: I'll put it on, put it on the calendar of things to do. And, I do remember probably a year or so ago having a conversation with Tim and saying  Tim. So what you're really saying is that I should just listen to you and get out of my own way and have you help me spread this message and that's why we're doing this. 

Tim Edwards: It is a joy to be able to bring this to people and hopefully open their eyes, pun intended, as to how they can manage what they're doing with their eyes. You know, like we said, this is the title of this topic is 20/20 is not enough. And you alluded to the topic that we're going to have next time seeing fast polyvagal therapy. 

Dr. Stephey: Well I, and I'm excited about it. So make sure you come back and listen to the next episode because motion processing or seeing fast and the polyvagal theory of affect and emotion, it's huge in our lives in ways that you just, you don't know and it's so not connected to 20/20, but it has everything to do with how we read body language and gestural language and facial expressions and how we develop those skills in ourselves and it's a powerful talk and I'm looking forward to the next episode. 

Tim Edwards: Thank you for listening to the Move Look & Listen Podcast with Dr. Doug Stephey brought to you by audible. Get a free audio book download and a 30 day free trial of audible membership at audibletrial.com/inbound. You'll find over 180,000 titles to choose from, including books mentioned here in the Move Look & Listen podcasts. You can listen to these books through your iphone, your android, your kindle, your computer, or even an MP3 player. And if for any reason and at any time you choose to cancel your membership, you keep all of your audio book, downloads. Give it a shot for 30 days. You got nothing to lose. Support the Move Look & Listen podcast by visiting audibletrial.com/inbound. We will include a link for your convenience, in the show notes of this and every episode of the podcast. And of course if you like some more information regarding Dr. Stephey's practice or to make an appointment, we will include links in the show notes to Dr. Stephey's website and his youtube channel. 

Tim Edwards: Dr. Stephey's website is stepheyoptometry.com. That's s t e p h e y optometry.com. You can also call the office at 626-332-4510. Again, all of Dr. Stephey's contact information will be included in the show notes of each and every episode. One last request before we let you go on to the next episode, please subscribe to the podcast from whichever platform you might be listening in. Of course, it is free to subscribe and it ensures that every time we post a new episode, you'll find it right there waiting for you to listen in your podcast app of choice. We really do appreciate your listening and until next time for Dr. Stephey of the Move Look & Listen podcast. I'm Tim Edwards with the Inbound Podcasting Network.

 

 

 

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