VT Works

For the benefit of our readers who may be meeting you for the first time, can you share how you found your way into Developmental Optometry and share your current role in the profession today? 

I have been fascinated by eyes and vision since I was a child. I was on the pre-med track when I discovered optometry as a profession, and it immediately clicked that I had found my calling.

During optometry school at Pacific University College of Optometry, I discovered how much I loved learning and found that I especially enjoyed working with children. I was drawn to the challenge of understanding how patients learn, develop, and interact with the world around them, which naturally led me toward developmental optometry.

It was also during optometry school that I was introduced to developmental and neuro-optometry. There, I began to understand why my mother had struggled with certain challenges throughout her life. She had experienced six concussions before she was 20 years old, and learning about neuro-optometry gave me a new perspective on how those injuries have affected her. That experience made the field deeply personal to me and reinforced my desire to help patients facing similar challenges.

I have been a devoted OVDRA member since optometry school, and I now have the privilege of contributing to the organization through my work on the Pre-Meeting Education Committee. I also serve as the Colorado OVDRA State Coordinator, where I organize an annual study group for optometrists and vision therapists throughout the state. It is incredibly meaningful to be in a position where I can give back to an organization that has played such an important role in my professional development and help support its future growth.

You’ve built your work around really listening to patients. What does that look like in your day to day practice?

Listening is one of the most important parts of what we do. Many of our patients have seen multiple providers before finding our office, and they often arrive feeling frustrated or unheard. We make it a priority to understand not only their symptoms, but also how those symptoms are affecting their daily lives, whether that is reading, learning, working, driving, or participating in the activities they enjoy.

That commitment to listening is reflected in the way we structure our care. Our administrative team spends time asking questions and helping patients articulate their concerns before they even walk through the exam room door. Initial evaluations are typically two hours long, which gives us the time to take a thorough history and perform extensive binocular vision and perceptual testing. After the evaluation, patients meet with the doctor for a 45-minute consultation to discuss their diagnosis and treatment plan.

We place a high priority on patient education because understanding and listening go hand in hand. I find that when patients have a clear understanding of their condition and why we are recommending a particular treatment, they feel more empowered and are often more successful in their program.

How do you balance clinical precision with the human side of care in your interactions?

I think the human side of care actually improves clinical precision. In neuro-optometry especially, patients’ lived experiences often reveal patterns that standardized testing alone may miss.

Many patients come to us after feeling dismissed or exhausted by persistent symptoms, so listening carefully and helping them feel understood is incredibly important in building a trusting relationship. When I spend the time listening to ALL of the patient’s concerns, I end up being able to narrow down my clinical testing to the most important ones. 

My goal is to provide highly individualized care that is both scientifically grounded and highly compassionate. Our whole team embodies this mindset, and the patients can feel the difference from the moment they walk in the door.

At this year’s Annual Meeting, you spoke on Visual Snow Syndrome, which is a condition still unfamiliar to many clinicians. What is the simplest way you explain it to someone encountering it for the first time?

The simplest way I explain Visual Snow Syndrome (VSS) is that the person constantly sees a layer of flickering dots or “static” throughout their vision, similar to the static on an old television screen. For some people it is mild, while for others it can be quite disruptive.

Visual snow is often accompanied by other symptoms such as light sensitivity, prominent after-images, flashes of light, visual trailing, or other unusual visual phenomena. Many patients also experience tinnitus or migraines.

We now understand that VSS is not an eye problem, but rather a disorder involving visual processing in the brain. Research suggests there is increased baseline activity and hyperconnectivity in the brain’s visual processing networks, which may explain why these visual symptoms occur.

Although Visual Snow Syndrome is often described as rare, studies suggest it may affect as many as 3% of the population. Because it is frequently under-recognized, I routinely ask patients whether they see “static” in their vision that looks like flickering or moving dots. Many patients are surprised to learn that what they have been experiencing actually has a name.

Many VSS patients have seen multiple providers before arriving in a vision therapy setting. What patterns do you tend to notice in their journey?

Many patients with Visual Snow Syndrome have spent years searching for answers. They have often seen eye care professionals, neurologists, and other healthcare providers, only to be told that their eyes are healthy and that nothing appears to be wrong. In some cases, their symptoms are attributed to anxiety, and they begin to wonder if the problem is simply “all in their head.”

One of the most powerful moments is when patients learn that the many symptoms they have been experiencing are actually connected by a common diagnosis: Visual Snow Syndrome. That recognition often brings an enormous sense of relief and validation. Simply understanding that their experience is real and shared by others can help reduce some of the anxiety surrounding their symptoms.

Another pattern I see is that many patients who have had VSS since childhood do not realize that what they are experiencing is different from a typical visual experience. In fact, approximately 40% of individuals with VSS report having symptoms for as long as they can remember. Because they have never known anything different, they often don’t recognize the extra visual burden they are carrying or realize that there may be ways to improve their symptoms.

One of the most rewarding aspects of my work is helping these patients understand what they are experiencing, giving them hope, and helping them navigate the path forward.

What role do lenses, prisms, and chromatic filters play in your management of Visual Snow Syndrome, and how do you decide where to begin?

I cannot overstate the importance of lenses, prisms, and chromatic filters for patients with Visual Snow Syndrome. While every patient responds differently, the majority experience meaningful relief with the right combination of optical treatment incorporated into their glasses.

When I listen to a patient’s symptoms, I begin forming hypotheses about what may be helpful. For example, patients with significant light sensitivity often benefit from tinted or chromatic filters. If a patient is experiencing dizziness or balance difficulties, I may trial small amounts of yoked prism. Patients with eye fatigue or headaches sometimes respond dramatically to relatively small prescription changes, whether that is plus power or astigmatic correction. For patients who are particularly motion sensitive, I will often explore the effect of small amounts of base-in prism.

One of the things I have learned from working with this population is that a patient’s greatest sensitivities often provide clues about where their visual system needs the most support. After completing the refraction and binocular vision evaluation, I have a clearer picture of what may be beneficial. From there, I put together several trial frame options and have patients walk through the office to experience how the lenses, prisms, or filters affect their perception of vision and space. Those real-world responses often provide invaluable guidance in developing an effective treatment plan.

Do you find there are common mistakes clinicians make when approaching VSS, either diagnostically or in treatment?

Let me start by saying that if you are recognizing and diagnosing Visual Snow Syndrome, you are already on the right track. One of the biggest challenges is simply identifying it. Many clinicians do not routinely ask about visual snow, particularly in pediatric patients. It only takes a moment to ask whether a child sees flickering dots or “static” in their vision, or to show them an image or animation of visual snow and ask if it looks familiar. A surprising number of cases can be identified with just a few targeted questions.

When it comes to treatment, I think one of the most common mistakes is overlooking small optical interventions. Patients with VSS can be surprisingly responsive to relatively subtle changes, whether that is a low hyperopic or astigmatic prescription, a small amount of yoked prism or base-in prism, a minor vertical prism correction, or a carefully selected chromatic filter.

I also encourage clinicians to spend time trial framing different options rather than relying solely on what looks best on paper. If a patient is uncertain about a tint, have them walk down the hall, look around the room, or read on a computer screen while wearing it. Their real-world response is often more informative than what they report while sitting behind the phoropter. And don’t be afraid to experiment with different tint colors or even different tints for different tasks. Small changes can sometimes make a meaningful difference in comfort and function.

Another pitfall is underestimating how much vision therapy can help reduce visual snow symptoms. Most of our patients who complete a vision therapy program report at least a moderate improvement in their symptoms. My theory is that vision therapy helps patients learn how to direct and organize their visual attention more effectively, while also improving overall visual efficiency. We place particular emphasis on activities that develop central-peripheral integration, simultaneous processing, and visual perceptual skills. Because Visual Snow Syndrome is fundamentally a visual processing disorder, it makes sense that patients can benefit from interventions that directly target visual processing. In my experience, vision therapy is an important piece of the puzzle and should not be overlooked.

Your philosophy speaks to individualized care, compassion, growth, and helping patients truly reach their potential—how has that vision shaped not just how you treat patients, but the culture and identity of your clinic as a whole?

It is very important to me to foster a workplace culture that values growth, recognition, and psychological safety. I have learned a great deal from Dr. Nancy Torgerson’s teachings about developing a strong team, and we focus on maintaining a growth mindset, a flat hierarchy, and effective communication so everyone feels valued and heard. We are mindful of workload and supportive of staff members pursuing new challenges and opportunities for growth.

I believe that the way we care for our team directly impacts the way we care for our patients. When staff members feel supported, respected, and empowered to grow, they are better able to extend that same patience, compassion, and individualized attention to the people we serve.

Education is highly valued in our clinic, and the team is constantly motivated to learn something new in order to better serve our patients. I am incredibly grateful to have such an amazing team at Denver Vision Therapy. All of our clinical staff are certified—our two doctors are Fellows of OVDRA, and our four full-time vision therapists have earned their COVT certification. If there were certifications for our awesome administrative team and my jack-of-all-trades optometric technician, they would have those too.

At the end of the day, I want Denver Vision Therapy to be a place where patients feel understood, supported, and hopeful, and where our team members feel those same things as well.

When you step back and look at your work, what do you hope the lasting impact is, both for your patients and for the profession?

When I step back and look at my work, I hope my lasting impact on patients is that they leave with a better quality of life and a greater understanding of themselves. It is always a privilege to help people improve their vision and overcome challenges that may have affected them for years. I am grateful to be a part of each patient’s journey and to build the long-lasting relationships that often develop along the way.

For the profession as a whole, I hope to leave a lasting impact through education. I enjoy teaching complex topics such as strabismus and Visual Snow Syndrome and organizing information in a way that makes it accessible and clinically useful. When challenging subjects are presented clearly, it gives doctors and vision therapists the confidence to expand their skills and better serve their patients.

One of the most rewarding aspects of teaching is knowing that its impact extends far beyond my own clinic. By helping other providers grow in their knowledge and confidence, I have the opportunity to improve the lives of patients I may never meet. That ripple effect is one of the things I find most meaningful about my role in the profession.

Closing Thoughts from Robert: A great thanks to Dr. Leanna Dudley for taking time out of her busy schedule for this interview. Dr. Dudley represents many of the qualities that define the very best of Developmental Optometry: intellectual curiosity, genuine compassion, clinical expertise, and an unwavering commitment to helping people improve their lives. Whether she is helping a patient finally find answers, supporting a colleague’s professional growth, or sharing her knowledge through education and leadership, her work seems rooted in the belief that understanding the individual is the foundation of meaningful care. As you read through her responses, it becomes clear that her influence extends far beyond the walls of her practice. Through the patients she serves, the professionals she teaches, and the teams she helps develop, Dr. Dudley is helping shape a future where more people are seen, heard, understood, and empowered to reach their full potential. Please join me in wish Dr. Leanna Dudley, her beautiful family, and her amazing staff, the very best in the future!