Son was just diagnosed with convergence insufficiency. Tell me all you know.

[*********]

We just returned from the developmental optometrist. She diagnosed Moose with convergence insufficiency.

 

I understand what this is/means, and it totally fits all his symptoms to a 'T'.

 

My major concern is the price of the perceptual exam and the vision therapy. They want $350 for the perception exam, and then $105 per session of VT. She suspects he'd need about 32 sessions of therapy.

 

The exam today was $140. Which means when all's said and done, we're looking at $3850 total over the next 9 months.

 

This is going to be hard to convince my dh of. I'm not bashing, and I don't want to get into it. I'm just stating fact.

 

*I* am totally on board with it, and think it will do a world of good. Doing school lessons with this child is EXHAUSTING; for both of us. I firmly believe that treating his convergence insufficiency will improve his quality of life.

 

So, tell me what you know about vision therapy. I've read the studies, and know that convergence insufficiency has been PROVEN in blind studies to be clinically effective at treating it, and that in office therapy combined with at home follow up is the most effective way.

 

Does anyone just do exercises at home and not do the office therapy? If so, where did you find the exercises to do? Does anyone go to therapy every other week instead of every week? I realize this would mean it would take ds a longer time to improve, but it might be a compromise dh could agree to. Would going every other week make the therapy less effective, or just take longer?

 

So many questions.

[Karen in CO]

My daughter did about a dozen sessions of VT in office for convergence insufficiency before we had to stop for scheduling and financial reasons. She improved drastically in that time. I don't know what a perception exam is. We didn't have anything like that, just the big exam that diagnosed her. Don't sign a contract that binds you to a set number of sessions or a set total cost. We paid as we went which is a good thing. Perhaps you can discuss the issue with the doctor to work out more homework and fewer office visits. As a warning, we had a hard time doing school while we were doing VT. It was a lot of work for her eyes and brain.

[*********]

Thank you, Karen.

 

I hadn't thought yet about how much strain this is going to put on him. I will definitely plan for "school lite" while we do the therapy. As it is, just the basics right now are all he can handle because of how exhausting it is for him.

 

Did you do 12 sessions at one session a week, or did you spread the sessions out more?

 

The 'perception exam' is apparently the 'second phase' exam that tells the therapist precisely where his strengths and weaknesses are so his therapy can be specifically tailored/targeted. The exam he had today was just a comprehensive eye exam (you know, the one with dilation) that helped pinpoint the 'area' he has issues with.

[NotSoObvious]

We did twice a week for three months. Do twice a week if you can! Be very diligent about the home exercises. We saw major improvements.

 

For us, going every other week would have really defeated the purpose. I would have had a hard time following through with home exercises for two weeks. We'd need more variety and accountability, plus there things she could only do in the office (3D stuff on the computer, trampoline things, etc).

[Mom-ninja.]

I'm not going to be any help because I'm just in a bad mood about the cost of any help/treatment/therapy that a child may need. It's ridiculous. Once again it is the average joe who gets the short end of the stick.

[laundrycrisis]

We got medical insurance coverage for both exams and VT for convergence insufficiency. This was with blue cross. It had to go to external peer review but was then approved as there are published peer reviewed studies supporting VT for this.

[Karen in CO]

We went mostly once a week, but sometimes it was two weeks between appointments because of scheduling. We were super diligent about the exercises at home and often did more than required.

[Joker]

My youngest is currently about halfway through her course of VT and I've seen huge improvements. She's reading again for fun and I see far less reversals and confusion with directional words. Her writing is getting there but she's still struggling a bit. She really likes it too, but it does make her tired.

 

I get the cost. Our dr's regular price is almost $600/month for once a week. We took an early morning appointment (since we homeschool) that no one else wanted and worked the price down to $340/month. Maybe you could talk with them and see if there is anything you could do to help with cost.

[Joker]

We got medical insurance coverage for both exams and VT for convergence insufficiency. This was with blue cross. It had to go to external peer review but was then approved as there are published peer reviewed studies supporting VT for this.

 

How exactly did you do this? We have BC as well and they've told me repeatedly they will not cover the VT. They do cover some of the exams and testing, though.

[kareng]

Bethany, my dd has been doing VT since last June when she was first tested. She did 6 months in the office (plus the work she does at home). Then we ran out of $$ (my mother helped us with one of those 3 months). Then we realized that she wasn't "done" with VT but we just didn't have the cash. So she is now doing once a month in the office with the rest done at home. I asked if there were other options. I have heard of some in the HIVE who have done every other week as well.

 

My dd had issues with pretty much all the areas that developmental optomistrists test for: binocularity, tracking (oculomotility), focusing, some vision perception issues (visual memory especially). So those deficiencies combined with dyslexia made teaching for me and learning for her very difficult.

 

She had headaches before with blurred vision along with double vision at times.. She just coudln't work for very long at school and we didn't make a whole lot of progress.

 

Since then, we have seen incredible improvement in both her attitude (Oh, I can do this now!) and her ability (she really can do it). And the headaches and vision issues are gone.

 

I remember first reading about it on this board and thinking, "There's no way we're going to pay for that!" One hive member suggested doing whatever it takes to do this (forgo a vacation, forgo buying curriculum or whatever it takes). I thought that was drastic at the time but I totally agree now.

 

And our dd was 14 at the time (when the testing was done). I would imagine that the sooner this can be found out and improved the better.

 

With that said, it's all worth it. I KNOW it's a lot of money but to see her able to do school work and enjoy life (being able to go out and track the geese flying over head -- she coudln't do that before) or focus on things near and then far away, is a blessing. For her to be able to enjoy her school work and do well at it, is a double blessing.

 

I'll be thinking and praying for you as you discuss this with your dh.

[VinNY]

We refinanced the house to cover the extra expense. They also did CARE credit and we put some on our VISA. Initial exam was around $500 and VT was $125 per session. We went twice a week for 6 months and did exercises at home. She also did an at home perceptual computer program. I saw improvement within 2 months. Prior to that my dd was getting speech OT O-G with private and school therapists and still could not progress with the written word. So they all saw a difference with her. I don't want to have to relive those 6 months but my husband and I have no regrets.

[prairiewindmomma]

We did a trial of the computer based stuff while we saved up for vt. Ds did not make much progress.

 

We could only afford 12 sessions....we're saving to do more. We did a lot of practice at home.

[PeterPan]

If the issue is won't vs. can't, then take your dh along and let the doc talk to him. If the issue is needing to get the price down, well talk with the doc, work on financing, or get them to give you more homework. My warning is that you accomplish A LOT more in one hour with the therapist than you will at home. Your kid will work harder and be more motivated. Dd typically got done in one hour with the therapist more than I could do in a WEEK. That's a huge, huge difference in timetable. The therapist catches a lot of stuff that you won't, even if you had their therapy exercises and tried to do it all yourself. You really NEED that interaction with someone who's experienced and can tell the dc how it should look, how it should feel, catch subtle signs that they need to adjust something, etc. If you have to make do with spaced sessions, do so. However if the money is there, stand your ground and get it done the way the doc says.

 

Yes, you can and should decrease or drop your school time for a couple months to let the VT kick in. Since things aren't going well, that might be a lot of the problem. Salmon spend a long time swimming upstream, wear themselves out, and die. Don't be a salmon.

[*********]

Thanks for all the input so far.

 

Dh and I haven't talked too much about it yet. He asked about the diagnosis and what the doctor recommended for treatment, but that's it so far.

 

First I'm gonna fight like crazy to get insurance to cover it. We'll see.

 

I have a link to the blind study that was done that proves in-office therapy combined with homework is the most effective way to treat this. I just need to get dh to actually read it and get on board.

 

It's really the money and a difference in priorities regarding money between dh and I right now. It's a matter for prayer, for sure. Dh has expressed that his major concern is what if we pay all this money for this treatment and then ds is no better off. I get it. But I truly believe if dh educated himself on this topic that he'd feel more comfortable.

[PeterPan]

Your dh's issue is TOTALLY reasonable. You're focusing right now on research that VT *can* work, but it REALLY DEPENDS ON THE DOC... I can't say this enough. No more studies. What you need to do is see their therapy room, talk with people who've used them, etc. My doc might be great and yours crap, and no amount of studies will change that. We talk with people REGULARLY on this board who got in with a bad doc who took their money upfront (something we DON'T recommend on this board) and who didn't deliver. If the doc is doing lots of paper therapy and no hands-on, they might miss sensory integration issues, retained primitive reflexes, etc. that could hold back the dc's ability to process.

 

So your dh is perfectly correct to be skeptical. Put a lot of energy into making sure you've got a GOOD, reputable doctor who has a program where progress gets checked regularly and the customers are satisfied. I assume you already did this. I'm just saying that's what would give *me* confidence. It's all about the doc and what results *he* gets and how satisfied *his* patients are.

 

Then the next thing is NOT to pay large sums upfront. Doesn't sound like your particular doc is asking that, so that's good. Paying a month at a time is fine. Paying for larger blocks, to the tune $KKK, can leave you with no recourse, no options, etc. You'll hear docs wanting that for compliance reasons. I go back to the idea that if I'm seeing results, you'll have no compliance issues. If you take my money and don't give results, I have no recourse. That's also what becomes the answer to your dh. You find out what realistic expectations are for the degree of issues your dc has, what reasonable benchmarks or expectations are, and you watch for them. You pay for a month at a time. We saw *slight* changes at a month, good changes at 2 months, and UNBELIEVABLE changes at 3 months. Your dc might take longer, but the doc should be very upfront about what he expects. You watch for that and you drop the hammer if it's not happening. (obviously talk with the doc first before just dropping, could be an explanation)

 

I would acknowledge your dh's concerns. It's a ton of money and yes, there are concerns. You take it a month at a time and talk with the doc about what reasonable expectations are. And definitely take him along to that eval appoint. Should give him the info he needs and will let the doc explain things.

[*********]

You're right, Elizabeth. If I can get dh to come to the exam, I think it will make a difference. I'll do my best to make that happen.

[prairiewindmomma]

There are pinterest boards out there that show different exercises and techniques. I found that helpful to show dh as well.

[*********]

Well, after a few hours of phone calls, I've discovered that our insurance does cover the testing and therapy.

 

A very helpful lady at the insurance company also told me that since I couldn't find a developmental optometrist in our area that's in network, that I could get a special expemption for them to reimburse us at the in-network rate.

 

God is good.

 

All this means that the dollar amount is significantly lower now than it was yesterday.

[Freckles]

A good friend of mine moved into our home for four months so her ds could have VT in our town. He was known as the best in our area at the time. Her home was six hours away. It helped her ds tremendously. I guess my point is that I believe VT works and is valuable even though I didn't learn this through experience with my own child. I'm so happy the insurance will cover it, and God is good!

[RamonaQ]

Our insurance covered. I can honestly say that I thought about 6 weeks of VT for convergence insufficiency seemed to show the greatest progress-- stamina for reading and not getting lost on the page-- and there was little improvement afterwards. I think 3 months would have been sufficient--quite sufficient. We were drawn in for some silly online phonics program, when our time would have better been spent with an O-G tutor, which we subsequently did and saw FAR greater gains per time for reading improvement. We did the therapy part at home with HTS and with in-office visits--

[PeterPan]

The time depends largely on the severity of the dc's issues and of course how efficient and effective the therapist is. We've had people come on here saying a year (with working hard the whole time, lots of exercises, just started off with major, major issues), and then you'll see posts like Ramona's saying 6 weeks about did it. You want to see hard work out of the therapist and not pay them to do stuff you can do yourself, definitely.

 

Our first three months were all the basic vision stuff (convergence, focusing, depth perception, blah blah). After that they started adding in a lot of visual perception stuff, connecting visual processing to working memory, ability to handle distractions while using vision, etc. We did several months of that (2 or 3, I forget) and agreed to stop because we needed more OT. Since then we've gone back and have a bit more to do if we ever get the chance, ugh. That's working on visual processing and keeping that convergence as good as we can get it (with the low tone).

 

So it's really going to vary with the person. The doc should give you a fair estimate, and you should have the sense that he's not wasting your time or $$, totally agreed.

[DyslexicParent]

The company HTS, Inc. only makes it available through eye doctors. According to the secret Doctor's Manual I read, it is sold to the doctors for less than $50 then recommends

"a two-pronged rate structure. When HTS is being used as a standalone VT program, the customary fee is approximately $295 to $350. This includes the cost of the program plus two or possibly three progress evaluations. When HTS is used as an adjunct to in-office therapy or as maintenance therapy, the fee is typically $99 to $150."

I paid less than the standalone price of $295.

Where and how can you get the hts computer program?

 

[TravelingChris]

My middle had this and we would see the doctor, I think, about every few weeks. We did exercises at home and when we went in, she would be checked and sometimes the prisms changed. She also ended up with an eyeglass prescription which had a prism in it. She wore those for a few years and then didn't need them anymore.