Date of Award

5-2026

Degree Name

Doctor of Philosophy

Department

Interdisciplinary Health Sciences

First Advisor

Kieran Fogarty, Ph.D.

Second Advisor

Mary Lagerwey, Ph.D.

Third Advisor

Alison Jenerou, O.D.

Fourth Advisor

Darren Oystreck, Ph.D.

Keywords

Binocular vision, grounded theory, interprofessional, orthoptics, vision therapy

Abstract

There are three distinct professions prominent in the field of pediatric vision care. They are ophthalmology, optometry and orthoptics. All professions are integral to the detection and treatment of pediatric binocular vision disorders. However, distinct schools of thought exist to describe the best approach to pediatric binocular vision disorders and their treatments. Literature often highlights two opposing schools of thought represented by the “medical” and “behavioral” approaches. While there is academic debate about the merits and pitfalls of either approach, there is a paucity of nuanced perspectives which more closely resemble the ways in which pediatric ocular clinicians approach diagnosis and treatment of pediatric binocular vision disorders. The aim of this project was to investigate and describe what factors shape the way pediatric ocular clinicians build their practice patterns with respect to addressing pediatric binocular vision disorders.

This study included 22 pediatric ocular clinicians practicing in the United States or Canada (9 orthoptists, 9 optometrists and 4 ophthalmologists). These individuals participated in 30-90-minute semi-structured interviews whose transcripts were coded and analyzed via Atlas.TI software by two coders. Straussian grounded theory methodology was used to analyze the transcripts. Five themes emerged: (a) clinicians adhere to the universal principle to do no harm, (b) clinicians are ambassadors of their profession’s objectives, (c) practice is shaped by individual experiences, not just evidence, (d) interprofessional relations are confounded by language barriers, and (e) all clinicians exist on a spectrum of practice.

The findings of this study promote a better understanding of nuanced perspectives that exist among pediatric ocular clinicians with respect to the treatment of pediatric binocular vision disorders. They can contribute to better communication among clinicians on opposite ends of the spectrum of practice and to the development of a more unified approach to treatment of pediatric binocular vision disorders.

Access Setting

Dissertation-Open Access

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