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Vision Therapy and Ophthalmologists


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#1 bluemongoose

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Posted 19 October 2017 - 03:30 PM

Has anyone had this kind of experience?

 

We went to our regular "eye dr." for my DS today. He has not had an eye exam recently because he has perfect vision. We have an evaluation for VT next week, and they requested a recent eye exam. 

 

The Dr asked us what problems we were having that brought us in and I said I was just there to have a routine eye exam and fax the info to the VT clinic. She then printed me a paper on vision therapy basically being unsupported for learning disabilities and not helpful. She asked me to read it and then went on to say I could still go if that is what I want, but it wasn't an eye issue and VT wouldn't be helpful. I never said he had a learning disability. I honestly am not sure what I am dealing with, but I thought the evaluation might be a good start. Is this common?

 

 



#2 EKS

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Posted 19 October 2017 - 03:46 PM

Yes it is common.

 

 


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#3 Crimson Wife

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Posted 19 October 2017 - 06:22 PM

Turf war. Think nurse-midwives vs. M.D. OB’s, chiropractors vs. orthopedists, etc.


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#4 prairiewindmomma

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Posted 19 October 2017 - 06:27 PM

I have had one ped opthamologist who pushed us to do it with a COVD, one who offered it in office, and one who said it was bunk. I agree, turf war.

Fwiw, most insurance companies say it is bunk as well so they don't have to pay for it.

My kid had his vision issues resolve after doing it, so I am pro-vt.
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#5 OhElizabeth

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Posted 19 October 2017 - 09:43 PM

Why did you go to a different doc for the regular eye exam instead of the VT doc??? You could have gone to the VT doc and they could have screened. Then you would have known whether it's even NECESSARY or warranted to do the full normal developmental vision screening.

 

How much are you being charged for this upcoming VT exam? Something already doesn't sound right. They shouldn't have sent you to another doctor for the basic exam. A good VT doc would have wanted to do it themselves, because they might have decided to use some special lenses or other things. To me, something doesn't sound right.

 

We had gone to a local doc for the regular before we went to the VT doc for a developmental vision exam. The regular doc gave reading glasses that the VT doc wouldn't have prescribed and the regular doc didn't catch the astigmatism the VT doc caught. 

 

Your regular doc is correct that VT is not for learning disabilities. VT does not cure dyslexia, dyscalculia, etc. etc. HOWEVER kids can have BOTH developmental vision problems and learning disabilities, and we regularly see kids who were diagnosed presumptively and lose their diagnoses or who get breakthroughs with VT they never thought possible with their disabilities. 

 

So it's turf war to say it won't help anyone, but it's correct to say it's not going to make a learning disability go away. 

 

So without the screening, you don't know if this full eval is even warranted. And if that's for real that the VT doc didn't want to do your regular eval, well that's so screwy I'd be looking for another doc. Things don't sound right. Why are you going? There's just nothing more frustrating that paying $$$$$$$ for an eval and realizing you don't like the doc. Doing that regular exam with the VT doc would have given you a way to meet, get screened, and see if he was even worth going to for the full eval. You want to be cautious. If you get in there and pay for the eval but don't like the doc, you have to start over with a different doc.


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#6 MerryAtHope

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Posted 19 October 2017 - 10:13 PM

Selective understanding (or selective reading... maybe they need VT too!). The American Academy of Pediatrics says in their statement abstract that “Vision problems can interfere with the process of learning” and THEN goes on to cite that they are not the cause of dyslexia. Practitioners seem to go crazy with the second part (vision problems don't cause dyslexia!) but completely ignore the first part (vision problems can interfere with the process of learning). 
 
The AAP statement goes on to say the following:
 
“Children with learning disabilities should undergo assessments of their health, development, hearing, and vision and, when appropriate, medical and psychological interventions for associated and related treatable conditions.”
 
Absolutely they should.
 
Practitioners read this quote
 
“Diagnostic and treatment approaches that lack scientific evidence of efficacy, including eye exercises, behavioural vision therapy, or special tinted filters or lenses, are not endorsed and should not be recommended.”
 
and completely miss that this quote was in reference to using these types of treatment approaches for Dyslexia and learning disabilities...NOT that these treatment approaches never have scientific evidence. As the AAP statement goes on to say, there IS scientific evidence supporting this type of approach for convergence insufficiency (they cite 8 articles supporting them for this use). They state:
 
“The ophthalmologist should identify and treat any significant visual defect according to standard principles of treatment….Symptomatic convergence insufficiency can be treated with near-point exercises, prism-convergence exercises, or computer-based convergence exercises.”
 
The AAP statement further states that it’s important for children to have complete screenings because treatable conditions can be missed or a child could be misdiagnosed:
 
“The recommended routine pediatric vision screenings are unlikely to disclose near-vision problems such as convergence insufficiency, accommodative insufficiency, and significant hyperopia.”
 
and
 
“Treatable ocular conditions can include strabismus, amblyopia, convergence and/or focusing deficiencies, and refractive errors. Missing these problems could cause long-term consequences from assigning these patients to incorrect treatment categories.”
 
So...while I might take issue with some things the AAP statement says, it actually says children should be screened for these vision processing issues, and that regular eye exams won't catch the issues! The issues are treatable through vision therapy (as cited by the AAP's referenced articles).
 
If someone just read the text that comes up on a google search without actually reading what the AAP says though, they'd be sure to think it's all bunk. 

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#7 OneStepAtATime

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Posted 19 October 2017 - 10:54 PM

What everyone else said.  In spades.  And in fact my kids' pediatrician and my kids' ophthalmologist both said there was no such thing as dyslexia and there is no such thing as developmental vision issues.  And they were wrong.

 

My kids are both dyslexic.  They ALSO both have developmental vision issues.  AND DD is nearsighted.  AND DS has perfect visual acuity.  Therefore, DD needs glasses and DS does not but they also both have vision issues that are not related to visual acuity and for which glasses will not help.  They also had real struggles with phonological processing.  Their developmental vision issues exacerbated the problem of reading but did not cause the problem.  The dyslexia is a separate issue from the developmental vision issues which is a separate problem from the visual acuity issues.  All affect their functionality in various aspects of their lives and all can be comorbid.  They are not an either/or scenario.  Not ONE medical practitioner, of ANY kind (in my area), seemed to be able to wrap their brains around the idea that multiple combinations of these things can be true in the same child and these things really do exist.  I had to seek answers elsewhere.  

 

 


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#8 SKL

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Posted 20 October 2017 - 02:28 AM

I agree.  I paid a lot of $$ to the pediatric ophthalmologist who did nothing but prescribe ordinary glasses for my kid (despite knowing she had a convergence problem).  Then when I asked for a copy of the prescription for the VT folks, they acted like I was hurting my kid.  VT made a huge difference for my kid, plus their exams are more thorough and cheaper.  I guess the ophthalmologists didn't like seeing the $$ go out the door.  Too bad.


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#9 bluemongoose

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Posted 20 October 2017 - 11:00 AM

I'll try and answer some of the questions...

 

The VT place is a local University that has an optometry and VT clinic and school. The providers in the clinic are on the COVD site.  I have had many friends in the OT and special ED fields recommend this place when they saw some of the issues I was having with my DS. I have an awesome pedi who is great at advising me where to go as well.  It was so long ago now that I don't remember if he originally brought up this place or if I did when we discussed the problems I was seeing. Either he did and I then mentioned I had some friends who recommended it too, or I brought it up and he sanctioned it. Can't remember. So I called the VT place. They asked if the boys had had a routine eye exam this year. One of my boys goes yearly and wears glasses, so he had gone this year. The other has 20/20 so he has not gone in a couple of years, so he hadn't. They asked me to fax YDSs eye exam information and then told me to schedule one either with them or through our regular eye dr for my ODS and fax his as well. As they didn't make a big deal about it not being through them, I didn't know it might be a problem. Our regular eye dr will fax it, she just didn't like that I was taking him.

 

I know that VT isn't for learning disabilities. I don't even know if they have a disability or not. I am seeing issues that look similar to stealth dyslexia and dysgraphia, but they have not been diagnosed with these. We have met the deductible this year, and the clinic is considered "in network", so we are just getting the evaluation to see if the issues are vision related or if we need to look elsewhere.  They are charging $150 per kid. 


Edited by bluemongoose, 20 October 2017 - 11:17 AM.

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#10 OhElizabeth

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Posted 20 October 2017 - 01:39 PM

Price seems good. Will it be students supervised by profs or the profs? We've done audiology (APD screenings) at a very, very well-regarded university, so I get why you'd be doing that. It just varies as to who is doing the testing. Personally, I wouldn't use students for this. If it's the prof, maybe. But really, who would be doing the therapy? Evals are to tell them what you need for therapy. So then you'd have students for therapy? There's actual training and certification for therapists doing the VT, and sometimes people who do it a *lot* get really, really good at it or have a personality that is a really good match with a particular dc. Also, make sure, sure, sure they screen for retained reflexes. Not all VT docs do. For real. Even though the development of vision involves visual reflexes which need the primitive reflexes and vestibular reflexes to have integrated properly. 

 

So it sounds like that whole conversation was with a receptionist, not a doctor. Keep asking questions. There can be holes in this approach, going through a university. You might want to see what your options would be privately as well. The price looks great for the eval, but if the therapy itself is going to be done by students, I'd be cautious. Really depends on your kid and how challenging they are to work with. And if they don't screen for retained reflexes, do it yourself.



#11 Crimson Wife

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Posted 20 October 2017 - 03:10 PM

I agree. I paid a lot of $$ to the pediatric ophthalmologist who did nothing but prescribe ordinary glasses for my kid (despite knowing she had a convergence problem). Then when I asked for a copy of the prescription for the VT folks, they acted like I was hurting my kid. VT made a huge difference for my kid, plus their exams are more thorough and cheaper. I guess the ophthalmologists didn't like seeing the $$ go out the door. Too bad.


Whether an ophthalmologist exam is cheaper than a developmental optometrist’s exam is completely dependent on insurance coverage. For our family it is not. The ophthalmologist exam is covered at 90% by our medical insurance if we see an in-network doctor. By contrast, only $80 of the total $400-something BV exam was covered by our vision insurance.

When DS was referred for a follow-up, I took him to the ophthalmologist as that is significantly cheaper for our family


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#12 laundrycrisis

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Posted 20 October 2017 - 03:31 PM

Ophthalmologists who say it is bunk are misinformed and spreading inaccurate information. We had about one third of our son’s VT covered by insurance. Basically they covered the visual motor parts which is like physical therapy for the visual system. They did not cover the visual processing parts.

Edited by laundrycrisis, 20 October 2017 - 03:32 PM.

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#13 SKL

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Posted 20 October 2017 - 04:02 PM

True, it can depend on insurance.  In my ophth situation I had to pay a large "specialist" co-pay for the partially covered annual visit, and 100% out of pocket for the other visit each year since he wanted to see my kid every 6 months.  The cost of each visit was $XXX, I don't remember exactly but not cheap.  The specialist co-pay was $50 each time.  Meanwhile the VT exam was about $100, and they did a lot more testing, told me what they found, and then actually did something about the problem.  VT exams have been all out of pocket for me so far, but still less out of pocket than the "covered" ophth.

 

Anyway, I am not recommending that people choose one over the other based on insurance.  It depends on the kid's specific issues.  It is pretty awful when either kind of doctor tries to prevent a kid in need from getting what another doctor could provide.  In this case, there is some duplication of expertise, but not enough to justify this kind of behavior.


Edited by SKL, 20 October 2017 - 04:04 PM.


#14 MerryAtHope

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Posted 20 October 2017 - 04:07 PM

 

I know that VT isn't for learning disabilities. I don't even know if they have a disability or not. I am seeing issues that look similar to stealth dyslexia and dysgraphia, but they have not been diagnosed with these. We have met the deductible this year, and the clinic is considered "in network", so we are just getting the evaluation to see if the issues are vision related or if we need to look elsewhere.  They are charging $150 per kid. 

 

Yes, you know--it's the optometrists/ophthalmologists who are against it that are not understanding the distinction! 



#15 kbutton

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Posted 20 October 2017 - 06:18 PM

Said cynically...if the child does VT, the ophthalmologist might not get to do surgery for those wandering eyes. Then surgeons might experience cognitive dissonance if they realize VT works. Then they might have to question their training. It could just get really ugly to change training based on, you know, science and stuff. 

 

;)


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#16 OneStepAtATime

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Posted 21 October 2017 - 12:01 AM

:lol:

Said cynically...if the child does VT, the ophthalmologist might not get to do surgery for those wandering eyes. Then surgeons might experience cognitive dissonance if they realize VT works. Then they might have to question their training. It could just get really ugly to change training based on, you know, science and stuff. 

 

;)

 


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#17 Rod Everson

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Posted 11 November 2017 - 12:25 AM

 I honestly am not sure what I am dealing with, but I thought the evaluation might be a good start. Is this common?

 

I'm a little surprised you go to an ophthalmologist for a regular eye exam, instead of an optometrist, but not at all surprised that an ophthalmologist would react the way yours did.

 

Here's a piece from my website that you might find interesting: Why Such a Secret? It explains why it's so difficult to get a diagnosis of a vision skills problem unless you see a developmental optometrist. 

 

In your case, the VT department appears to be a stand alone operation, probably to avoid some of the business complications I described in the link above. Or else they were just trying to save you the expense of an initial eye exam if you'd already had a recent one done.