As a resident in pediatric optometry, with a focus on binocular vision, Dr. Joanne Jin has gained experience in advanced patient care.
Dr. Joanne Jin sets up the vectogram to prepare for a binocular vision training session.
By Ameera Khan
Dr. Joanne Jin earned her Doctor of Optometry degree from the University of Waterloo School of Optometry and Vision Science in 2024. Since then, she has been part of a joint residency program between the Waterloo Eye Institute and Bolton Optometry Clinic where every week she spends two days on direct care and one day on vision therapy in Bolton and then two days at Waterloo either doing direct care or supervising fourth-year interns. As her 13-month residency wraps up this August, Dr. Jin is preparing to transition into private practice, bringing with her a strong foundation in advanced patient care.
Why did you decide to pursue a residency in pediatric optometry?
I decided to pursue this residency program because I was looking for a condensed and mentored learning experience before delving into private practice all on my own. Optometry school prepares you for all sorts of patients, but after fourth-year rotations it still felt a bit daunting to treat and manage specialty pediatric or binocular vision cases on my own. I particularly wanted to see what I could do to help children's vision and development beyond annual eye exams, which pointed me in the direction of binocular vision.
What is binocular vision?
Binocular vision has to do with how well the eyes work together with each other and with the brain. Common binocular vision conditions seen in pediatric optometry include strabismus and amblyopia.
Amblyopia is when the vision in one or both eyes is reduced, even when a patient wears optimal glasses or contact lenses, because of factors that have discouraged eye-brain communication, and as a result, discouraged vision from developing properly. The brain comes to rely too much on information coming from the stronger eye and ignores information from the weaker eye.
Strabismus is an eye turn. When you look at an object, both eyes should be pointed at that object. With an eye turn, one eye is fixating on the target, and the other eye might be directed outwards, inwards or even vertically misdirected. The eye that is not looking at the target is either ignored or turned off by the brain, so the brain does not get confused by input from two eyes looking in different directions.
Binocular vision problems are often treated through optical correction, vision therapy, and/or vision rehabilitation.
What are vision therapy and vision rehabilitation?
Vision therapy and vision rehabilitation are specialized treatments designed to help the eyes and brain work better together. Both approaches focus on improving binocularity – how well the eyes work together – and visual perception– how well the brain interprets visual information.
Vision therapy is often used when someone hasn’t developed strong eye teaming or tracking during childhood. It helps train the brain to use both eyes as a team, improving how they focus, track and work together.
Vision rehabilitation is geared toward people who’ve had a brain injury or trauma that disrupted their visual system. It helps restore or improve how the eyes function together so that patients can get back to their activities of daily living and work to the best of their abilities.
Both vision therapy and vision rehabilitation involve in-office sessions where the patient goes through eye exercises or activities under the guidance of an optometrist or a trained vision therapist. These activities target different areas of binocular vision or vision perception. Usually, a patient gets “homework” to practice some of the exercises at home. At a follow-up appointment they can advance the activity or move on to something more challenging.
Vision therapy is especially effective in childhood because that is when your brain is the most neuroplastic or capable of change, but it can also be effective in adults as there is still residual neuroplasticity. If we can encourage and reinforce binocularity at a young age, patients are less likely to be affected by conditions like strabismus or amblyopia in their adulthood.
What kinds of non-binocular conditions do you see in pediatric optometry?
We see many ocular health conditions in pediatric optometry similar to those seen in primary care. The most common are bacterial, viral, and allergic conjunctivitis, styes, and refractive conditions that are corrected by glasses.
What were some highlights of your residency?
A highlight of this last year was definitely the people that I got to work with, which includes my lovely co-residents, supervisors and the staff.
Another highlight has been working directly with patients and seeing the progress they have made, not only in terms of eye teaming but also in terms of improvements reflected in these children’s academic and sports performance. While this has been a highlight, it can also be challenging to figure out the next best steps for patients who are not having as much improvement and troubleshooting that.
One of the unique aspects of binocular vision and pediatric optometry is the need for creative problem solving. Sometimes, the standard in-clinic activities don’t fit every child’s needs, so we adapt by modifying exercises to better engage the patient, encourage their cooperation and attention and target their specific challenges of binocularity. It’s a process that keeps us thinking and learning, and it’s incredibly rewarding to see how these tailored approaches help children thrive both in in-office sessions and also for homework.
For example, in vision therapy, we use mazes to improve oculomotor skills. I remember working with one four-year-old child who had strabismus and amblyopia, and his eye turn manifested more for distance objects. We normally use pens and mazes on paper, but with this child, I ended up using a red marker on a clear sheet to create a racetrack that we could project onto the wall, and then he could use a laser pointer to make his way through the track while we could observe how well his eyes were working together and strengthen his eye teaming, and he could have a little fun being a racecar driver.
Has anything surprised you since starting your residency?
What I've learned through residency is how underrecognized vision therapy still remains among both the public as well as healthcare and allied healthcare practitioners. Awareness of vision therapy has definitely been increasing because there's now more research and evidence about its efficacy and the conditions that benefit from VT. Still, there remains a chunk of patients, whether they're children or adults, who have a condition that can benefit from something like vision therapy but nobody has recommended this or referred them to have a binocular vision assessment.
Any advice for optometry students considering residency?
Prior to deciding if residency or the specialty area of interest is right for you, you should reach out to the residency sites, ask to shadow the current residents and supervisors and shadow other optometrists who practice in the same field so that you can have a better understanding of what the specialty entails and whether you enjoy working in this field or not.
Ask the program and its coordinators any questions you may have because you are choosing the residency program just as the residency program is choosing you. You have to make sure that the clinic, structure, supervision and learning objectives line up with what you desire from the program and how you see yourself practicing in the future.