Please tell me that vision therapy isn't for life!

[kareng]

My dd has been doing vision therapy (VT) for 4 years.  Half of that time was spent going to the office every week, with a retest every 3 months. That was when we had "good" insurance that at least covered the 3 month retests.  Now we don't have that insurance so my dd goes for a one time VT session to learn the "new" exercises to do at home and then we go back for the 3 month retests.  The only way we've been able to do this is because a relative has offered to pay for those visits.

 

I do know that my dd has improved, I was thinking that she was doing well and that we could move to going once every 6 months and then go to a yearly checkup.  However, at her last 3 month recheck (last week), we were told that she might have to have VT for the rest of her life! I was shocked and thought how do people pay for this and is that a reasonable expectation that one would have VT for life????  I have had confidence in this doctor up until this point. She has said that she doesn't want my dd to just stop VT because she would regress.  Every 3 month visit, the Dr. brings up how much better it would be if my dd could have VT at her office every week. And, every time we go, I tell her that we can't afford it. Being confused and stressed about all this, I asked the Dr. to write up where my dd was when she came to her office 4 years ago, where she currently is (in her progress) and what her  goals are for my dd.

 

 

 I am concerned that there may come a time soon when our relative can no longer help us and we'll have to stop. I don't want to leave my dd at a disadvantage but if that's how things go then that will have to be that.

 

 

Does anyone have any sense of how long someone has to do VT? Four years seems a long time to me.  Is there any way just to do all of the VT at home?

 

Thank you for your input. I am a bit baffled and confused and will appreciate whatever advice/wisdom you can share.

[hornblower]

I would definitely seek out a second opinion because our treatment was short & well defined. 

Are you seeing someone who is a member of COVD? http://www.covd.org/
 

[OneStepAtATime]

I would definitely seek out a second opinion because our treatment was short & well defined. 

 

Are you seeing someone who is a member of COVD? http://www.covd.org/

 

Agreed.

 

I agree, though, that this really depends on what the VT is for, how severe the issue, etc.  Unfortunately, with certain types of developmental vision issues there IS regression without VT being fairly consistently followed, sometimes for many years, but if you are able to work with her at home I don't know that it is a realistic expectation from the doctor for her to go to VT for the rest of her life.  At some point she may just have to do VT at home only.  What is she getting VT for?  How severe is the issue?  Would prism glasses help at all?

 

Most VT is for a limited amount of time, not forever.  I would definitely get a second opinion and make certain you are using someone listed on the COVD sight with a good reputation.

[PeterPan]

There *are* some people who just aren't going to make good progress, no matter what.  It's typically people with significant disabilities.  There just are those biological limits sometimes.  However, what you're describing doesn't make sense.  Even with just monthly therapy and lots of homework, she still should have been done in a reasonably timely manner, say a year.

 

Has she had an OT eval?  When VT isn't sticking, that's the most normal reason why.  I'd want an OT eval to see if any retained primitive reflexes or other issues pop up, and then I'd let it ride a few months and get an eval by a DIFFERENT eye doc.  NO eye doc should be stringing you along like that, no matter WHAT.  Ours told us to take a break when we stopped making progress.  I would want a 2nd opinion before continuing.

Edited April 4, 2016 by OhElizabeth

[kbutton]

I would want a second opinion. 

 

If you see an OT, besides asking if they check retained primitive reflexes, get a detailed answer about what they do if they find them. Lots of people say they check retained reflexes. This can mean a lot of things. It might mean that they simply watch the child to see if they think they might need to check them. :-) 

[geodob]

Kareng, after 4 years of VT, their is little potential for any further improvement?

So that the only issue, is possible regression?

Where it would probably be good to continue doing the same VT exercises, for the rest of their life.

 

But for the doctor being to recommending weekly visits after 4 years?

Maybe you could ask the doctor if your weekly payments would be used to pay off their new car or boat?

If so, can you stop the weekly visits, once the car or boat is paid off?

Or perhaps they will want a new one by then?

So that life-long weekly payments/ visits, might be better?

[prairiewindmomma]

We did a round of vt a few years ago, were stymied by OT issues, and started putting our money towards OT instead.  Ds absolutely still has vision issues and we're likely to start VT again for another short round.  We did see improvement the first time around, but we're now trying to figure out how to best balance ds's needs with our budget.  There are real physical limitations to what we are going to be able to accomplish, and we're at the difficult point of trying to decide how good is good enough. If she has gained skills, she should be using them enough in her everyday life to maintain them.  

 

This is for your high school senior?  It's a bit late in the game to start new OT work or VT, but if you want to pursue things, I would do a 2nd opinion eval or an OT eval.  At least, then, you'd have some perspective on where she's at and you'd discover any underlying issues that may be easier to fix.

[Arcadia]

The gap that VT is trying to close is usually never fully close so in a sense VT is for life.

 

However needing VT sessions for life is unlikely. The marginal returns on what you pay for drop especially if your doctor can tailor the home exercises for maximum efficiency.

 

I had VT visits once a month and had exercised to do at home. In a year, there was a significant improvement and I was told to just continue the exercise at home. I did slack and regress but at the latest optometrist visit, the optometrist commented that I could just start back the exercises at home.

[kareng]

To answer a few questions:

   Yes, This VT doctor is part of COVD. and Yes, this is for my high school senior.  Time has just gone by (mostly because of issues with my mother's declining health and the energy we have put into helping my mother) that I didn't realize so much time has been spent on VT. I just got into a place of implicitly trusting that all was well with the VT doctor. And, we were making progress.  That is, until this last visit and then I realized I need to ask some more questions and get some answers.

 

 

Here are some notes from my dd's initial eval report that says the following: (from 4 years ago) --

 Ocular Motility (tracking) - "On the well standarized Developmental Eye Movement test, she scored in the 20-25% percentile for her age."

Binocularlity (eye teaming) - "Tests to assess her ability to integrate the information coming into her two eyes reveal a significant instability. She has a substantial Convergence Instability. That is, a there is a a strong tendency for her eyes to aim further than they should when engaged in a near-point tasks such as reading and writing. "

Accommodation (visual focusing) - "Her ability to maintain visual focus on a near point target such as a book or page is poor. This is referred to as accommodative insuffiency. In addition her accommodative system is quite unstable, which is contributing to the intermittent blur at distance. Her ability to change focus from distance to near and back is also deficient, called accommodative infacility."

Visual Processing and Integration - "Her ability to process and interpret incoming visual information was asses in several ways.  On the non-motor Test of Visual Perception (TVPS) her score was in the 66th percentile overall. This is a demanding test with seven subsections. On the Motor Free Test of Visual Perceptual Skills (MVPT) her global score was in the 16th percentile. Sections that were hardest for her were visual memory and visual discrimination."

 

In rereading this, it seems like my dd went into VT with lots of issues. I know she's made some good progress (her tracking is good now) but I don't have the specific numbers which is why I asked for a report of where she's been, where she is now, and what are we aiming for?  In reading the above (for those who are familiar with VT), does it sound like she needs VT for life?

 

 What would OT do? Is it too late to have her evaluated?

[prairiewindmomma]

My kid went in with the same issues, and lower scores.  Our goals for him are to be able to read acceptable lengths of time accurately, and without eye fatigue and for him to read with both eyes.  In his current regression, he has gone back to reading only with his dominant eye.  I think that is an acceptable reason for us to do more vision therapy.....but I certainly don't think he needs it for life.

[PeterPan]

There are some retained primitive reflexes that affect vision and how the eyes move across the midline.  You can google and find tests for retained primitive reflexes and do them yourself.  They're a common reason why VT doesn't stick.  Some OTs can check for them as well.

[Arcadia]

For these area; Ocular Motility (tracking), Binocularity (eye teaming), Accommodation (visual focusing), my PE teacher (masters in physical therapy) and my VT asked me to practice doing

 

- finger to nose test -> I kept missing my finger initially

 

- throw up a tennis ball juggling style and try to follow the motion. Downsize to a smaller ball like a golf ball or ping pong ball when confident

 

- take a pencil or pen and focus on the tip while moving the pencil towards and away from you. That is mainly for eye teaming. My DS10 has this problem and he is a slow reader. He is working on it.

 

My last VT at an eye clinic was at 23 years old. I had almost no depth perception when I started VT at my university hospital's eye clinic. In less than a year, my depth perception was close to normal.

 

While I choose not to drive, I could after VT do parallel parking on a slope and also park reverse in without problem as a L plate driver. If for any reason I have to pass a driving exam, I would splurge on VT just to not be a road hazard.

 

My official diagnosis was lazy eye (amblyopia) and squint (strabismus) from being a premature baby. I was able to do archery, billards and any aiming game if I use only one eye to focus.

[kareng]

For these area; Ocular Motility (tracking), Binocularity (eye teaming), Accommodation (visual focusing), my PE teacher (masters in physical therapy) and my VT asked me to practice doing

 

- finger to nose test -> I kept missing my finger initially

 

- throw up a tennis ball juggling style and try to follow the motion. Downsize to a smaller ball like a golf ball or ping pong ball when confident

 

- take a pencil or pen and focus on the tip while moving the pencil towards and away from you. That is mainly for eye teaming. My DS10 has this problem and he is a slow reader. He is working on it.

 

Arcadia - are the above exercises done with glasses on or off?

 

Edited May 19, 2016 by kareng

[kareng]

Since I posted this, the VT Dr. wrote up a report (Good ocular health, significant myopia; now able to fixate and track a moving target with smoothness and accuracy;  convergence insufficiency - strong tendency for her eyes to aim further than they should when doing a near-point task - and if a task is strenuous or extended or she's fatigued, one of her eyes turns out and aims at a different point in space).

 

I had a chance to speak with the VT doctor. In the past four years, We have had 3 units of office based Optometric Vision Therapy. The rest of the time we've gone in for a VT session then my dd has done it at home for 3 months, then we go back to have a check up, do another VT session, go home and do the same thing.  I shared with her my concerns - only doing it because a relative is helping financially (which may end), understanding that dd has to do this for life, and dd not improving. 

 

The Dr. said that dd's eyes are improving, it was just slower this past 3 months (not as dramatic or obvious); that she doesn't think dd needs VT for life, just perhaps until her body stops growing (done by 19 or 20) and had no tips on how to make this work better at home -- she said that much of what is done in the office VT visit is using a computer or special equipment that you can't duplicate at home AND that my dd is very diligent at doing the exercises at home so it's hard to improve on that.   I'm not sure it's worth pursuing another dr. at this point -- the closest one is quite a distance away and there are many other things pressing on our time right now - an elderly mother needing care, etc.

 

So that's where we stand for now.

[Arcadia]

The exercises are done with glasses on but DS10 and I did the exercises sometimes with glasses off because our nearsightedness is very low.

 

I was told that reaching full adult growth tapers at 25. So the window for improvement doesn't taper at 19/20.

 

I have photosensitive eyes and some equipment doesn't work as well for me because of the light. It is easier for me to do non-machine vision tests.

[kbutton]

Our therapy was a therapist (person) working 1:1 with our children. It was not computer-based. I would look for something that involves a person.

[PeterPan]

In general convergence insufficiency resolves within just a few months of weekly therapy.  Most therapy is done in-office with a person (and some computer sometimes) for maybe an hour a week and then there is homework.  What do you mean by units?  Honestly, it sounds like you didn't get enough actual homework and actual therapy.  Were there any CHANGES to the homework over that three months??  

 

We had someone else come and say oh VT doesn't work, blah blah, and it was something similar where, for whatever reason, that practice would leave kids with the same tasks for extended periods of time and get no progress.  The problem is the doc and I'm sorry it's happening.  I'd also be wondering about retained reflexes.

 

Convergence insufficiency is SO easy to treat that it's ABSURD that this quack has not gotten it done.  Find someone else, drive there once a week, every other week, whatever, get a LONG LIST of homework tasks, and get it done.  I'll bet two months and you'd be done with a doc who had half a clue what he was doing.

[kareng]

OhElizabeth, each "unit" was 3 months.  Are retained reflexes the piece that OT addresses?

[PeterPan]

Just depends on what people are trained on.  RMT is a pretty common method for OTs to use for retained reflexes.  Sometimes the VT docs will know how to work on them, and sometimes they refer you out for OT.  

 

Were you getting weekly therapy during that time?  Or you're saying she went in for a session and was given homework to do for three months?  How many things were on that homework list if that was what was happening?  The *norm* is weekly therapy and constantly changing/building tasks.

Edited June 1, 2016 by OhElizabeth

[kareng]

My dd would go in every week for weekly therapy and then have things to do at home every day between those weekly visits.  Then after 3 months, she'd be re-tested to see how things were going.  As to number of things she did at home - probably 2 or 3 things (can't remember it was a while ago now) and then she'd go in and they shift things around so that she'd be working on different things at home. When funds became tighter, that's when we shifted to one VT session (to learn new task), then do that for 3 months, come back in to be re-tested, learn a new task, then go home for 3 months, etc.

 

Oh, OK about the OT piece. I think you mentioned that before.  Nothing about OT was ever brought up and I never knew to bring it up.

[PeterPan]

Well if your pricepoint is free, there are plenty of videos online to check for the retained reflexes yourself.  

[kareng]

Hey folks, I appreciate all that you have written and I've been pondering what to do at this point.  My attention has lately been with my elderly mother and some family health issues so I've lost some steam over this.  But... I am considering seeing another COVD certified eye doctor.  Are any of you from Western MA and know of some good doctors within an hour's drive of 01301 zip? 

 

I am going cross post this as well since I doubt loads of folks are part of this one.

 

Thanks so much! :001_cool:

 

Edited June 13, 2016 by kareng

[PeterPan]

Good, because I was wondering how it was going with you!  I hope you find someone!  Did you check the COVD listing?