VT Second opinion

[MommyX8]

I want a different doctor to assess my son. I canceled my appointment with my first doctor and he sent this note:

 

Dear Mr. and Mrs. *******,

 

I am concerned about your response for possible Vision Therapy for ******.

 

The visual evaluation provides solid reasons why you are at your wit’s end with ******. He has significant problems with use of his eyes: he does not have adequate binocular vision which affects comprehension, and his focus ability is significantly low which inhibits sustained attention with detailed tasks.

 

All of these visual efforts create problems with reading comprehension and school work in general. These problems cannot be addressed by any academic means such as tutoring: I am unsure as to how you can address any future academic achievements without considering these visual processing issues.

 

Our fees are very much in line with standard medical care. Braces these days are running close to $8,000 to $10,000, and most people do not hesitate to provide orthodontic care for their children. Vision abilities for successful learning are as important as straight teeth.

 

If you need more support for what we do, there are many scientific articles that our website provides. The bottom line is that ******* poor vision processing is causing academic difficulties and a poor attitude towards school in general.

 

If you would like to discuss this further, I would be happy to do so.

 

I have to say that I am a bit put off by this note. Opinions? This is the doctor who charges $145, $7300 for the year, upfront.

[FairProspects]

Run far, far away. We had a doctor bully us like that and we lost time and money and it was a terrible experience for all involved. Burn the note, and have him evaluated by someone else. Any doctor who would write that is only after your money. These people prey on parental fears for our children and it just infuriates me.

[PeterPan]

Sorry, but that letter reads as rude to me. He has all kinds of VAGUE claims and is conflating adhd and vision. VT isn't for adhd. And no, no, no, no, no, NEVER, EVER, NEVER, EVER give ANYONE a year's worth of therapy $$ upfront. What in the WORLD is your recourse if the guy is a scam artist?!?!

 

I don't even know why you're reading his letter. Seal it back in the envelope and bury it deep in some drawer.

 

See, here's the deal. If he's GOOD and everybody who knows him knows he's good, then he shouldn't be afraid of you getting a 2nd opinion. I think these docs are hurting right now with the bad economy (as many people are). People are putting off things like vision care, and so he's not really an impartial judge on this. You're perfectly reasonable to want a 2nd opinion, and under NO circumstances should you give him that much money upfront. When people come on the boards and say they get burnt by scoundrels, that's one of the scenarios that it's sometimes part of. We've heard it enough. It's illogical and unnecessary. Don't do it and don't let the guy ruin your day. Move on honey. If he's great, you can come back to him later. Sounds like though he's the wrong kinda tuna. :ack2:

[MommyX8]

Thank you for your encouraging words.

 

This doctor just doesn't sit well with me. And some of the things that he as on his test report seem to be there only to instill fear.

 

I am attending a Dianne Craft seminar next weekend. And I will find a vision therapist that is willing to work with me and re-evaluate periodically.

[PeterPan]

Well good. I was worried for you after you deleted your other posts. I couldn't figure out if we had offended you or what. I'm glad you're sorting it out. He's young and VT is expensive no matter who does it. They should be showing you concrete things. They should be picking up vision tools and having the kid do something and then explaining to you how he did, what the age-appropriate range is, blah blah. They should be doing a visagraph so you can see eye movement. It should be very concrete. No voodoo, no doctor telling you how to teach the kid to read.

 

Hope you like the Dianne Craft thing! I think she's been to conventions in our state, and I've just never heard her speak. You should report back what you learn and what strikes you the most. :)

[mamakelly]

I totally agree with OhElizabeth. A visagraph printout doesn't lie, you can see what's going on when you see that print out. There are other things that they can say, "see he can't do this and he should be able to." And a dr who wants that much $$ upfront is wacked imo!

[DyslexicParent]

I was worried for you after you deleted your other posts. I couldn't figure out if we had offended you or what.

I was wondering the same thing when I was trying to learn about vision therapy.

He has all kinds of VAGUE claims and is conflating adhd and vision. VT isn't for adhd..

What exactly has vision therapy been proven efficacious for? It seems to be the most popular treatment in this site, but when I research it, all I find are warnings from the International Dyslexia Association, American Academy of Ophthalmology, American Academy of Pediatricians, American Association for Pediatric Ophthalmology and Strabismus, Susan Barton, etc. :confused:

[TranquilMind]

I want a different doctor to assess my son. I canceled my appointment with my first doctor and he sent this note:

 

Dear Mr. and Mrs. *******,

 

I am concerned about your response for possible Vision Therapy for ******.

 

The visual evaluation provides solid reasons why you are at your wit’s end with ******. He has significant problems with use of his eyes: he does not have adequate binocular vision which affects comprehension, and his focus ability is significantly low which inhibits sustained attention with detailed tasks.

 

All of these visual efforts create problems with reading comprehension and school work in general. These problems cannot be addressed by any academic means such as tutoring: I am unsure as to how you can address any future academic achievements without considering these visual processing issues.

 

Our fees are very much in line with standard medical care. Braces these days are running close to $8,000 to $10,000, and most people do not hesitate to provide orthodontic care for their children. Vision abilities for successful learning are as important as straight teeth.

 

If you need more support for what we do, there are many scientific articles that our website provides. The bottom line is that ******* poor vision processing is causing academic difficulties and a poor attitude towards school in general.

 

If you would like to discuss this further, I would be happy to do so.

 

I have to say that I am a bit put off by this note. Opinions? This is the doctor who charges $145, $7300 for the year, upfront.

 

Dude is Pushy. It's just business, not personal, but this is pushy. The best ones don't need to push this hard. His "concern" is that you may pay someone else, not that you may not get the help your kid needs. That's the most off-putting thing in what he said (his first sentence).

 

Get your second and third and maybe fourth opinion.

[TranquilMind]

Thank you for your encouraging words.

 

This doctor just doesn't sit well with me. And some of the things that he as on his test report seem to be there only to instill fear.

 

 

Always trust your instincts.

[TranquilMind]

OhElizabeth: And no, no, no, no, no, NEVER, EVER, NEVER, EVER give ANYONE a year's worth of therapy $$ upfront.

I love how he tried to analogize his services with orthodontic work - for the specific reason that the standard is that one pays for orthodontic work up front. So see...you need to pay HIM up front too, and an even higher price than standard orthodontic work. Yikes.

 

What in the WORLD is your recourse if the guy is a scam artist?!?!

 

None.

 

See, here's the deal. If he's GOOD and everybody who knows him knows he's good, then he shouldn't be afraid of you getting a 2nd opinion.

 

YES!!!

[PeterPan]

I was wondering the same thing when I was trying to learn about vision therapy.

 

What exactly has vision therapy been proven efficacious for? It seems to be the most popular treatment in this site, but when I research it, all I find are warnings from the International Dyslexia Association, American Academy of Ophthalmology, American Academy of Pediatricians, American Association for Pediatric Ophthalmology and Strabismus, Susan Barton, etc. :confused:

 

I'm confused if you're asking or accusing, sorry. VT is for vision problems. Things that get discussed on the boards here go in phases and stages. A year or two from now the mix will be totally different. Your username says dyslexia. VT is not a treatment for dyslexia. VT is for physically diagnosable VISION problems that sometimes people with dyslexia turn out to have. These are real optometrists doing the VT, so it's not like this is some self-proclaimed treatment by people who thought up their qualifications. There is a board for getting certified, and the therapists can also get certified. (COVD)

 

Generally VT is recognized with being effective for convergence insufficiency. There are some other vision problems where an extremely good developmental optometrist can make headway using VT and help the patient avoid surgery. The COVD website has info on all that, and you can google and sort it out for yourself. We all know there's controversy and difference of opinion. There's also some turf war stuff going on. There are things VT can be highly effective for, and there are some people who paint it like it's going to cure everything and their brother. Same thing happens with chiropractors. I go to the chiropractor for my back, and he fixes my back. It's a legitimate physical problem, easy to quantify (like developmental vision problems). Some chiros go further and say that if you keep properly adjusted it makes your energy flow better and improves your health and this and that. Ok, so now we're getting out there in these ancillary effects, sort of down the road things. Yes some kids' behavior improves with VT. Yes some kids' dyslexia reverses with VT. But it was because there were LEGITIMATE PHYSICAL PROBLEMS underlying the behaviors and the VT addressed the physical problems.

 

When you go to a developmental optometrist and get an eval, you're expecting concrete demonstration of legitimate physical problems. If you don't get that, walk away. It's not voodoo. They showed me the physical problems, we did the therapy, we saw the vision tasks get better, we enjoyed the results of the improved vision. Plain and simple. No voodoo or anything vague.

 

As for the reason it's so common as an issue, well the eyes are controlled by muscles and the neurological system. So if you have kids with neurological issues (retained primitive reflexes, etc.) it affects eye function. If you have kids with hypotonia (which many spectrum kids, etc. do), then the eyes are affected. No voodoo.

Edited October 28, 2012 by OhElizabeth

[stripe]

I thought the idea of prepaying for a year was a bad idea. Find someone else.

[DyslexicParent]

I was asking so thanks for the info. My poor DD has endured dozens of tests already, including more coming up for FASD and auto-immune disorder (perichondritis), so I'm wondering if it's worth testing her for developmental vision, central auditory processing disorder, dyslexia, etc. So instead of going to her long-time optometrist for her free annual eye exam, I should pay a developmental optometrist ~$174 for a 90-minute 12-point eye exam?

I'm confused if you're asking or accusing, sorry. VT is for vision problems. Things that get discussed on the boards here go in phases and stages. A year or two from now the mix will be totally different. Your username says dyslexia. VT is not a treatment for dyslexia. VT is for physically diagnosable VISION problems that sometimes people with dyslexia turn out to have. These are real optometrists doing the VT, so it's not like this is some self-proclaimed treatment by people who thought up their qualifications. There is a board for getting certified, and the therapists can also get certified. (COVD)

 

Generally VT is recognized with being effective for convergence insufficiency. There are some other vision problems where an extremely good developmental optometrist can make headway using VT and help the patient avoid surgery. The COVD website has info on all that, and you can google and sort it out for yourself. We all know there's controversy and difference of opinion. There's also some turf war stuff going on. There are things VT can be highly effective for, and there are some people who paint it like it's going to cure everything and their brother. Same thing happens with chiropractors. I go to the chiropractor for my back, and he fixes my back. It's a legitimate physical problem, easy to quantify (like developmental vision problems). Some chiros go further and say that if you keep properly adjusted it makes your energy flow better and improves your health and this and that. Ok, so now we're getting out there in these ancillary effects, sort of down the road things. Yes some kids' behavior improves with VT. Yes some kids' dyslexia reverses with VT. But it was because there were LEGITIMATE PHYSICAL PROBLEMS underlying the behaviors and the VT addressed the physical problems.

 

When you go to a developmental optometrist and get an eval, you're expecting concrete demonstration of legitimate physical problems. If you don't get that, walk away. It's not voodoo. They showed me the physical problems, we did the therapy, we saw the vision tasks get better, we enjoyed the results of the improved vision. Plain and simple. No voodoo or anything vague.

 

As for the reason it's so common as an issue, well the eyes are controlled by muscles and the neurological system. So if you have kids with neurological issues (retained primitive reflexes, etc.) it affects eye function. If you have kids with hypotonia (which many spectrum kids, etc. do), then the eyes are affected. No voodoo.

[Lecka]

I went to my son's regular optometrist, but on his intake form, wrote that he was having trouble with reading and was very frustrated with it .

 

She was able to do some screenings for him and refer me to a developmental optometrist. She was not the COVD one in town. I went to her instad of the COVD one. However I did talk to the COVD one on the phone for quite a while and I have a good impression of him.

 

This is how it played out.... he could show convergence insufficiency, but only if he was stressed/tired (at the end of the exam). He didn't show it at the 2nd exam. He had showed it at another exam a year earlier, when that optometrist said it was developmentally okay for his age but to watch it.

 

His sign would be to move his face close to a book and then pull back.

 

I was told -- the best thing is keep his face back from the book, he will have an easier time, it is at a closer distance that he has more difficulty. And, keep an eye.

 

This year I am not seeing it at all, and I am not seeing other signs I had read of on the COVD website.

 

So I ended up thinking that his frustration was from difficulty with reading and not his eyes.

 

But my experience with the optometrists and talking to the COVD optometrist on the phone was good.

 

They were all saying, that if it got worse I should do more, but for his age and expected reading requirements, he should be okay. Basically -- at the time, he could probably not sustain reading more than 10 minutes, but as that was more than he would be expected to do, it wa sokay, but watch it, b/c it would not be okay a year or two later.

 

I do still keep an eye on this and it is on my radar if he seems to tire too quickly in reading as the time demands increase.

[PeterPan]

I was asking so thanks for the info. My poor DD has endured dozens of tests already, including more coming up for FASD and auto-immune disorder (perichondritis), so I'm wondering if it's worth testing her for developmental vision, central auditory processing disorder, dyslexia, etc. So instead of going to her long-time optometrist for her free annual eye exam, I should pay a developmental optometrist ~$174 for a 90-minute 12-point eye exam?

 

That doc doesn't even mention developmental optometry on his website. On the COVD list, he's only an associate. When I pulled it up, there are *6* other docs in Ontario who are Fellows with COVD. I don't know if those docs are a reasonable distance, but I would do some checking into your options.

 

Yes, I suggest to people that they simply get their *regular eye exam* but do it with the developmental optometrist. If he's a good developmental optometrist, he'll screen for the developmental issues in that regular eye exam. IF he finds something concerning, then you do the longer, more expensive developmental eval. If the screening turns up nothing, then you can check it off your list without a lot of expense or hassle. Where we are, a developmental eval is $250 and a regular exam is $60-100. You have to have a regular exam before the developmental eval anyway. Doing the regular one first just lets you meet the doctor, make certain you like him, and screen before going through the expense of the longer, developmental exam. In a developmental exam they'll hook them up to the computer to track their eyes, do all sorts of testing, etc.

 

So I think your instinct is correct. I'd just keep looking and see if you can find someone within a doable drive who does more developmental optometry.

[PeterPan]

I went to my son's regular optometrist, but on his intake form, wrote that he was having trouble with reading and was very frustrated with it .

 

She was able to do some screenings for him and refer me to a developmental optometrist. She was not the COVD one in town. I went to her instad of the COVD one. However I did talk to the COVD one on the phone for quite a while and I have a good impression of him.

 

This is how it played out.... he could show convergence insufficiency, but only if he was stressed/tired (at the end of the exam). He didn't show it at the 2nd exam. He had showed it at another exam a year earlier, when that optometrist said it was developmentally okay for his age but to watch it.

 

His sign would be to move his face close to a book and then pull back.

 

I was told -- the best thing is keep his face back from the book, he will have an easier time, it is at a closer distance that he has more difficulty. And, keep an eye.

 

This year I am not seeing it at all, and I am not seeing other signs I had read of on the COVD website.

 

So I ended up thinking that his frustration was from difficulty with reading and not his eyes.

 

But my experience with the optometrists and talking to the COVD optometrist on the phone was good.

 

They were all saying, that if it got worse I should do more, but for his age and expected reading requirements, he should be okay. Basically -- at the time, he could probably not sustain reading more than 10 minutes, but as that was more than he would be expected to do, it wa sokay, but watch it, b/c it would not be okay a year or two later.

 

I do still keep an eye on this and it is on my radar if he seems to tire too quickly in reading as the time demands increase.

 

Lecka, the nice thing is you can take him for his regular eval to the COVD doc next time. Then they can do the screenings themselves. Like you say, therapy isn't always necessary. They look at the whole picture of what is age-appropriate, what is happening and whether something else is compensating, etc. My ds they're just watching. I feel more *confident* having the dev. optom. do his regular appointments, because that way I know it's getting watched and NOT an issue. It can actually change from year to year, where a child was fine and later tips the scales and needs it. I don't really know why that happens and haven't heard an explanation.

[Lecka]

My insurance doesn't work that way.

 

The explanation I heard is not so much that the child's eyes get worse, but that they should be iimproving every year in meeting the demands of school. They said that looking at things at the school desk-to-head distance is not natural in child development but most children learn it as they do school and get a little better every year.

 

The COVD optometrist, from talking about my son specifically, was saying when he was 8, with no therapy, he would very likely have the CI down. Not guaranteed, but very likely. He said if schools did not make the demands there would not be a problem for my son. But if he was going to fall behind in school, and I thought it was causing a problem, and wanted to pursue it, etc etc, he could provide therapy to get him to that level a little quicker. But it was clear that was not why he got into vision therapy, iykwim. (I was talking to him as the mother of a 6-year-old with an anwer of "no" to every question he asked of "does he show this symptom?")

 

So I was thinking, for a little while, that it might make it a lot easier on him to not have to do two things at once, to do the reading part of reading and the eye-focusing part of reading, at the same time, when the reading part was so hard for him. But I went to flashcards with big letters and gave him lots of breaks, and did letter tiles, and some things like that, to try to make it easier on him, and when we do paired reading he gets lots of breaks but still gets a lot of practice.

 

I am still watching for it, b/c my son does have fatigue from reading after reading about one page, and 1.5 pages is too much. But that is reading out loud. Reading silently he does not fatigue so quickly. So right now I think this means, reading out loud for him is more difficult than reading silently, and I don't think it means that he is having eye fatigue. But he can only read silently so long before he gets fatigued, too. But I think an appropriate (short-ish) amount of time for a 7-year-old.

 

It is on my radar, but I was looking at it from a perspective "this is too hard for my son and it should not be" and wanting to make sure I wasn't missing something. I really did not have a suspicion it was his eyes, and his speech issues were very obviously a major problem. But that was when he was having trouble with his handwriting, too, and before he started OT... OT has basically gotten him writing on the baseline instead of above and below. I had thought the above/below the baseline thing was maybe a VT thing but very close to that time I had his IEP meeting and met the OT and she had done an assessment with him and she was confident she could work with that. She had given him a test of visual processing that he passed, also, and I was asking the COVD optometrist on the phone if he knew about the visual processing test he had taken for that (it involved copying and tracing shapes). He could not say if it ruled out all vision problems or not, he was not familiar with the specific test the OT had done. My son had gotten some crazy low scores (he got a 1st percentile on one sub-score) on his actual letters so I was wanting to do my due diligence on that.

 

I think in a year or two I might pay for a regular exam from the COVD. It would have been cheaper than your quote (I live in a low-priced area). But it is free to go on post and I am happy with the optometrist he sees. She seemed knowledgable to screen him if not to do an evaluation.

 

edit: So anyway my understanding of the reason it would tip the scale, is that the expected level goes up every year, so if it is fine one year, but then doesn't progress, then it could be too low for the new age/grade expectations, even though it was okay for the previous year, and great for the expectations of two years prior.

 

edit again: They also, basically, would see his eyes cross when things were on the close side to his face. So he could just make a point to hold his head back a little from his reading and writing, and not put his face closer and closer, that is what would strain his eyes, for him personally.

 

edit again: I know what his previous symptom looked like, of holding his head forward and then pulling it back... I used to see it when he was writing, and some with reading (but he quickly got used to holding his books a little further from his eyes as suggested). And, I am not seeing it now. So I feel like, at this point, it is fine. But I do appreciate the idea of taking him to the COVD for a check-up. We would pay for that but I think it would be worth doing. Our insurance requires us to go on post and then be referred for anything off post... but then it would not pay for vision therapy. It would pay for an evaluation but not therapy. And if I was going to get therapy, it would be from the COVD optometrist, not the one who we were referred to for the evaluation. So, sigh. But he has seen 3 optometrists for this.

 

The 1st one he went to after failing the "4 dot" screening at his school. The school nurse had no idea what this meant. I went to a random optometrist and he spent a long time with my son. He said he did think he was acceptable for his age (he was 5 then) but that it needed to be watched. But he did not explain it to me very well. He said things consistent with what the COVD optometrist said (the next year) but I had more background knowledge then to understand it. Then I was just like, tell me if he needs glasses, and he was telling me he didn't recommend glasses, he recommended watchful waiting.

Edited October 29, 2012 by Lecka

[LittleIzumi]

 

Yes, I suggest to people that they simply get their *regular eye exam* but do it with the developmental optometrist. If he's a good developmental optometrist, he'll screen for the developmental issues in that regular eye exam. IF he finds something concerning, then you do the longer, more expensive developmental eval. If the screening turns up nothing, then you can check it off your list without a lot of expense or hassle. Where we are, a developmental eval is $250 and a regular exam is $60-100. You have to have a regular exam before the developmental eval anyway. Doing the regular one first just lets you meet the doctor, make certain you like him, and screen before going through the expense of the longer, developmental exam. In a developmental exam they'll hook them up to the computer to track their eyes, do all sorts of testing, etc.

 

So I think your instinct is correct. I'd just keep looking and see if you can find someone within a doable drive who does more developmental optometry.

 

:iagree: Ours did a regular vision exam on both dds. One was brought back for the full exam and needed a lot of VT (which I expected, as she had amblyopia and serious reading difficulties that weren't related to anything else, like being able to read a word in isolation but not in a sentence), while the other dd passed the normal exam with flying colors and no VT work was needed.