Back from the dev optometrist today. Anyone...

[NCW]

ever go for vision therapy and NOT see positive results?

 

Dd had minimal fixation troubles, not much else, with a definite tendency to use her right eye, rather than both together.

 

Ds, OTOH, had multiple issues that even I could see (the optometrist had me stand next to him watching their eyes during the testing so that I could see just what their eyes do). So there's lots of new vocabulary - convergence insufficiency, exophoria at near vision, esophoria at distances, nearsightedness, astigmatism (knew about those last two already), fixation challenges, and a tendency for his eyes to turn very slightly in, especially his left. I think that covers it, but I'm not sure! The main ones that make reading so very hard are the double vision and poor fixation (which makes you miss all the little words in reading).

 

So the issues are there. One eye doctor in town gives out a pamphlet from the American Academy of Ophthalmology saying that vision therapy for learning disabilities is a bunch of hooey without any scientific evidence to show it works.

 

Last week I asked for research articles. You sent me links! Thank you.

 

Today I'm just asking if anyone sunk $$ into this and didn't have success. The Optometrist is very sure he can help both my kids. For $8000-$10,000 or so (10 sessions for $2000, probably combined they'll need 40-50 sessions).

 

Thanks,

NCW

[Maria/ME]

My daughter JUST saw a Dev. Opt. and has convergence insufficiency...we haven't done a lot of other testing yet but there may be some other stuff. I have been reading tons and didn't realize until it was pointed out to me by someone on anothe board that the whole vision therapy thing is like the relationship with Medical Drs and Chiropractors. They are a little wary of each other. So I do think you're going to hear some negative.

 

Just trying to search under 'unsuccessful vision therapy' and so forth, I can't pull up much. I only am finding positive things about it. Cost is certainly high isn't it? I hope you get more input on the subject. I was just going to post here about my daughters experience. If you are interested it's on my blog....meanwhile, just writing to say I know the boat you are in....

[Claire]

It's certainly possible to spend $10,000 on vision therapy and be disappointed with the results. No therapy I know of will guarantee results. I'm sure there are parents out there who have spent that much money and been disappointed with what they got for it.

 

Many children with learning difficulties need more than one therapy to achieve complete remediation. 50 hours of in-office VT *did* correct my dd's multiple severe visual efficiency deficits. However, it didn't help her reading very much. This is because the years of handicapped vision had interfered with her acquisition of cognitive skills. To fully realize the benefits of corrected visual efficiency skills, she needed a cognitive skills training program. The cognitive skills training cost about the same amount as the VT.

 

Most parents need to become wise consumers and think hard about possibilities before putting too many $$$ into any one basket.

 

I think I mentioned before that there are many ways to do VT. All in-office VT is the most expensive way to go. Have you asked this doctor if he would be willing to design a primarily home-based program to keep costs down? I would urge you to explore your options for VT before committing so much money to a single therapy. If your son is like my dd, the VT alone won't be enough and you will be disappointed in the results unless you continue on with additional therapies.

 

The optometrist is confident he can correct the visual efficiency deficits that have been identified, and I would be confident of that too. However, just correcting the visual efficiency deficits may not be enough to significantly improve your child's ability to learn. You may want to consider less expensive ways of doing VT in order to save money for other therapies down the road.

[NCW]

Thanks for your responses.

 

I did speak with them about home exercises. Ideally, they would like to do in-office treatment 2x/wk, 1 hour sessions, or 1 session for 1 and a half hours. I'm thinking 1 hour/wk with home exercises in-between. They did say that daily home exercises are crucial to success. I think that with one-hour weekly sessions and a strong home program we could perhaps maximize our benefits and minimize the cost. Does that sound reasonable? Or should I ask them for even more home exercises and to visit them bi-weekly?

 

It's over an hour drive away, and with twice weekly OT already, it's been a tough year to get academics done.

 

NCW

[Claire]

Thanks for your responses.

 

I did speak with them about home exercises. Ideally, they would like to do in-office treatment 2x/wk, 1 hour sessions, or 1 session for 1 and a half hours. I'm thinking 1 hour/wk with home exercises in-between. They did say that daily home exercises are crucial to success. I think that with one-hour weekly sessions and a strong home program we could perhaps maximize our benefits and minimize the cost. Does that sound reasonable? Or should I ask them for even more home exercises and to visit them bi-weekly?

 

It's over an hour drive away, and with twice weekly OT already, it's been a tough year to get academics done.

 

NCW

 

I personally don't think 1-1/2 hour sessions are a good idea. The child gets too tired.

 

When we did in-office VT, we went twice a week for the first four months for one hour sessions (actually more like 45 minutes). A 45-minute session was plenty for my dd, and they warned me not to plan on any reading or close activities after that because her eyes would be tired. After the first four months, we went once a week for an additional four months. We did not do exercises at home except for color therapy -- which is an entirely different kettle of fish from other types of VT exercises.

 

Assuming your dc is cooperative about working with you at home, I would ask for one one-hour session a week and more home exercises to try to keep costs down. Many optometrists are afraid to send home too many exercises because many families do not do the home exercises consistently. They know that if they see the child twice a week that there will be significant progress even if the parents are not doing what needs to be done in-between sessions. Especially with the one-hour drive you have, I would think they would be amenable to one session a week.

 

If money is a real problem for you, and you think you can handle doing more of the exercises at home, by all means be very frank and ask if he can give you more to do at home so you only have to come in every two weeks. I know a couple of parents who arranged to go in just once a month and did exercises at home in-between. The only reason I don't mention trying for this is because different children have different types of vision problems, are more or less cooperative about doing the exercises at home with a parent, and different families are able to fit in daily exercises better than others. I myself, at the time we did VT, did not feel confident about being able to do the exercises at home consistently. Although our optometrist actually volunteered to design a primarily home-based program for us, I opted for almost all in-office therapy instead. I felt like a monkey had been taken off my back. For the level of anxiety I had at the time, doing the VT in-office was worth every penny. (But our VT of 50 hours 7 years ago added up to about $2,500 instead of $10,000! I was able to get a discount by pre-paying for 10 sessions at a time, plus this was a non-profit that worked hard to keep their hourly costs down.)

[NCW]

Thanks, Claire. The fact that he wants us to do home exercises, then, builds my confidence. We've done that kind of thing for OT, so we can add on VT!

 

Which brings up another question - is it typical to require cash payment in advance for 10-session blocks?

 

I called today to ask them to send me detailed evaluation reports to take to our primary care doc in hopes that our insurance will cover at least a portion of it.

 

Thanks for all the info,

NCW

[Claire]

Which brings up another question - is it typical to require cash payment in advance for 10-session blocks? NCW

 

I have no idea if this is typical. Probably not. Our clinic was a non-profit that served a charter public school for exceptional children. My dd went in as an out-patient because she did not attend the school. We were offered choices about how to pay, and the discount for up-front payments was one of them.

 

FWIW, my dentist offers a 5% discount for cash payment in advance of work for which it is known insurance will pay only a portion (say, for veneers or crowns). I'm sure he does that because it cuts down on his costs of mailing out bills and reminders, and possibly having to go to small claims court and still not being able to collect.

 

If I were you, at some point I would ask if you could get a discount by paying cash in advance.

[NCW]

Thanks. I'll let you know how things work out.

NCW

[Kathy in MD]

I called today to ask them to send me detailed evaluation reports to take to our primary care doc in hopes that our insurance will cover at least a portion of it.

 

 

 

YOu posted that your ds's eye turns in slightly. Because that is conventionally treated by surgery and eye surgery is typically covered in the major medical portion of your insurance, your ds's therapy should be covered. I'm not sure about your dd's treatment.

 

Unless your insurance company has already asked for the complete reports, have your DO send in the minimum needed to request coverage. For my insurance company, that was the standard insurance claim form with the appropriate codes that are accurate, yet ensure coverage. I'd be afraid that a complete report might mention so many other problems that the insurance company would deny coverage because what they would cover is only a small % of the itemized problems, irregardless of % of time spent.

 

Oh, I also agree with Claire that VT will very possibly not turn your dc into instant readers. Even my ds's OD was frustrated because ds's reading wasn't better at the end of the therapy. :rolleyes: My ds needed additional work on auditory processing and memory training before his reading really took off.

[Alexandra]

it was making my ds sick. He literally became nauseated and was white as a sheet. We had an in-home program that cost $500-$600. I have been told that opthamologists are starting to come on board and offer their own version of VT but have to wonder about that. Since our VT experience, I have asked several MDs what their opinion is about VT and have never been offered an opthamologist's alternative.

With that type of money being charged you really need to get a second opinion from a different optometrist. If you really want your child to go through VT ask for an in-home computer program.

Also, you might try asking area opthamologists (MDs) for a program. If one is available, it stands to reason that it would have a better chance of being covered by insurance.

It is depressing to think about how entirely uncharted this territory of reading and learning difficulties is. There are plenty of folks who are happy to take you money though - that is for sure.

Best of luck.

[Claire]

Very, very few opthalmologists offer orthoptics (their version of vision therapy) even though the U.S. Assoc. of Opthalmologists created orthoptics as a sanctioned specialty several years ago -- when the independent research confirming the effectiveness of vision therapy for convergence and accommodation problems became overwhelming.

 

It's interested to Google orthoptics. You will see that opthalmologists *never* use the term "vision therapy" and refer to orthoptics as "muscle retraining". They really dislike the fact that optometrists developed this field, and they don't want to be associated with optometrists at all. Orthoptics is actually just a subset of the exercises offered by developmental optometrists. There hasn't yet been enough independent research on the effectiveness of VT for tracking, saccades, field-of-vision constriction, and other visual efficiency problems for them to incorporate those exercises into orthoptic practice.

 

If the home vision therapy was making your ds sick, he probably should have been receiving in-office therapy for that particular issue. Home computerized therapy is effective for a lot of problems, but it does not adequately address all visual efficiency issues.

 

A lot of the problem with getting insurance coverage is coding. It doesn't matter so much whether the VT is done by an orthoptician or a developmental optometrist, but many clinics do not know how to code the problems for insurance purposes.

[Rod Everson]

With that type of money being charged you really need to get a second opinion from a different optometrist. If you really want your child to go through VT ask for an in-home computer program.

 

 

I agree with the comment about checking with other optometrists, as long as they are COVD-certified. You might be lucky enough to have two of them located within driving distance, in which case I would ask for some parent references, visit their therapy centers, check prices, etc., before deciding which one to use.

 

However, if you are serious about addressing your children's vision issues, I think you should go with an in-office program rather than a computer program. The OD will be doing progress checks and letting the vision therapist know what needs more work, what to work on next, etc.

 

The VT in my area is 45 minutes once a week with daily home exercises, unless parents are not able to work with their child, as sometimes happens. Then it is done several times per week and gets a lot more expensive.

 

I teach reading to the kids who've finished vision therapy and the difference is night versus day. After vision therapy, they are much easier to teach, with many of them actually finally utilizing the phonics knowledge that they were taught earlier.

 

About half of the kids who come in for vision therapy can already read, but they are not comfortable doing so. They get headaches, have to read and re-read, can only read for short periods of time, etc. These kids benefit from vision therapy also, even though they can already read.

 

I've seen so much of this over the past several years that I'm now of the opinion that every child who struggles with reading should be assessed by a developmental optometrist. It's that big an issue, and it's very common. And, with a good VT department, most of the stories will be success stories. As with everything else, however, there are those who are not so good, so it makes sense to see if their waiting room has satisfied parents. Some of them will be bringing a second child in, or sometimes even a third.

 

Good luck, whatever you decide,

 

Rod Everson

OnTrack Reading

[NCW]

I've spent a lot of time on the phone. The opthalmologist in town primarily does surgeries. It is likely (though his office staff didn't say so) that the VT he does is generally post-op support. They stated he generally gives you exercises, and then checks back with you in one to six months.

 

VT's, I guess, vary greatly in the kinds of techniques they use to treat even the same diagnosis - just depends on their bag of tricks, individual experience, etc., just like any other kind of therapy.

 

So, of the two places within driving distance, the one with the best reputation is also the one that doesn't prescribe the computer treatment. Because we have to pay for it anyway, I guess I'm going to go with reputation.

 

FWIW, they also said that often they have better luck with insurance reimbursement if you don't go and try to get pre-authorization (like I just spend half of yesterday trying to do). I guess insurance companies turn it down for pre-auth, but will sometimes just pay if a bill is submitted to them. I hope I haven't shot myself in the foot on that one...

 

I'm a fairly quick learner, and have done/do therapy exercises with my kids already, so I think with a strong home program we will be able to reduce the amount of hours we have to actually purchase.

 

This has been an interesting learning voyage.

 

NCW

[Claire]

FWIW, they also said that often they have better luck with insurance reimbursement if you don't go and try to get pre-authorization (like I just spend half of yesterday trying to do). I guess insurance companies turn it down for pre-auth, but will sometimes just pay if a bill is submitted to them. I hope I haven't shot myself in the foot on that one...

NCW

 

I think it's all in how the therapy is coded. Here's a link to a post on the old boards from someone who was able to get insurance coverage for her vision therapy. (The link is to her coding thread, but read the whole thread to see what her optometrist did.)

[Claire]

Actually, here's a link to the beginning of that thread.

[NCW]

Claire,

thank you! I've printed them and will check with the VT about it.

NCW