Vision Therapy Question

[sangtarah]

Dd 8 had an initial evaluation for developmental vision issues. Convergence excess, tracking, binocular vision were terms used to describe her. 

 

They said she needs to come back for another, more thorough evaluation before the doctor sits down in a conference with us and tells us her treatment plan. 

 

Is this a normal sequence? 

 

What does convergence excess mean? 

 

Are there any exercises we could do at home?

[laundrycrisis]

I would ask for an exact list of what they will be testing for in the second evaluation. It may be to determine how severe the visual motor problems are, and it may include some visual processing tests. They should be able to tell you exactly. The whole process should be as transparent as you ask for it to be. Convergence is the eyes coming together to hold binocular focus on an object as it comes closer. Over convergence means they go too far, like when you cross your eyes and see two pictures. Or that they don’t move back apart when they need to. Our DS had trouble diverging.

Edited October 16, 2017 by laundrycrisis

[PeterPan]

Yes, all the things they're saying are the appropriate terms and a normal way of doing it. I really like that they gave you a screening before doing more in-depth testing. That way, if you don't need more hours of testing, you aren't getting billed for that. 

 

So yeah, sounds on-track. Has your dc had an OT eval or been checked for retained reflexes? If the optometrist did not check for retained reflexes, then I would google that, look on youtube, get that done. There is a sequence to the development and integration of reflexes. If you don't integrate primitive reflexes, then the other reflexes that follow (visual, vestibular, etc.) don't develop properly. So you can be looking down the road and going oh vision problems and it be a symptom to back up and look at the earlier things. It's definitely something to check. Don't rely on the optometrist or even an OT to get it right. Many don't. 

[kbutton]

 

Are there any exercises we could do at home?

 

A good therapy program usually has homework. Our therapist said that it makes a huge difference in the outcome when kids do the homework. I think they aimed for at least 4 times per week for homework. Five was better.

[Rod Everson]

Regarding your questions: 

 

Yes, it's similar to what is done in the VT practice I'm familiar with. The optometrist does an initial eye exam similar to one you'd get anywhere, but also tests for poor binocular vision skills. If problems are found, a full developmental vision exam is recommended. During that exam, usually administered by a vision therapist, various vision skills are tested and scored. Once that has been done, the child's various strengths and weaknesses are known and a therapy plan is proposed.

 

Convergence excess is a tendency to over-converge. That would, as someone else said, be similar to crossing your eyes, but in this case your child might do that routinely and not even realize it. She has trouble relaxing her eyes and might see double as a result. Binocular vision problems are the result of poor convergence skill, so those two are related. Basically a binocular vision problem just means that both eyes aren't working well together. Tracking problems just mean that she has problems smoothing moving her eyes from left to right, as we do when we read. The developmental vision exam done later would reveal how significant those tracking problems are when reading.

 

As for exercises that can be done at home, no, not if you're looking for a different route to go than vision therapy. First, you'd have to know what you're trying to accomplish and for that you need the assessment. Some exercises, for example, would aggravate a convergence issue if they were intended to address the more common issue of convergence insufficiency. Her eyes might get even tighter, instead of relaxing, as she needs to learn to do in her particular case. But, as someone else also pointed out, you do want to see the therapist assigning programmed homework because that's the most effective way to proceed. That is, they do some new exercises at the clinic, show you how to do them at home, and then you make additional progress at home, recheck at the clinic, etc. If they did all the exercises at the clinic, it would be much more expensive because you'd be paying a therapist to do what you can do at home.

 

During VT, the therapist will measure progress and change exercises as needed to move your daughter along to new levels of any particular skill and then on to new skills that need work. That's what you'd be paying for, i.e., knowing what needs to be done next to build various vision skills to acceptable levels.

 

Incidentally, the VT department here has an observation window where a parent can watch the developmental vision assessment (the next test being recommended). Doing so would give you a good idea as to the particular skills that VT is intended to address, and would also be a good way to better understand what your daughter can and can't do among the various vision skills addressed in therapy.

 

Hope this helps...Rod

[sangtarah]

Thank you, Rod! Extremely helpful.

 

We have the next evaluation on Tuesday. I’m hoping all will go smoothly! The fee for this evaluation also includes the conference for results and 3-4 sessions afterward.

[exercise_guru]

 

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