Talk to Me about Vision Therapy

[OMama]

DS is 3.5 YO and has intermittent strabismus (eye turns inward and upwards) and nystagmus (eye rapidly flickers on occasion). We have been seeing an ophthalmologist at our Childrens Hospital who has recommended he wears bifocals, which DS has been doing for the last few months. This doctor has said that if DS wears the glasses constantly that by the time he is 10 YO that he may not need them at all any more and that the problems will have been corrected. This doctor does not "believe in" vision therapy.

Recently we had an appointment with a doctor who specializes in vision therapy and of course she is recommending doing it. Unfortunately insurance won't pay for it and DS would need a lot of therapy and it is expensive. What concerned me was that this new doctor said that she believed vision loss (ambylopia) was already occurring, since DS rarely moves his eye past a certain point, but she also said we could stop it--if we do vision therapy. So, what should we do???

Have others had success with vision therapy? How old were your kids (or yourself) when it was done and for how long? Is it worth the money? Again, it is a lot of money and obviously a time and energy commitment, but of course if it will save my son's vision then I would go into debt for it, but is it worth it? And did you work with your child doing exercises at home too?

Also, I am going to appeal with the insurance company but I've been told I have a slim chance. Has anyone had any luck appealing in a situation like this?

Thanks!

[sbgrace]

I think our insurance would cover for certain issues. They covered us for portions of the therapy.

We had different issues in that Andrew's were totally convergence and tracking so not your situation. But I believe if you do research you'll see it's been shown to work in situations like yours (I believe..look up studies w/strabismus). That's why our insurance would pay for it for the proven areas. In our case Andrew went from totally unable to catch a ball, steer a trike, do puzzles/writing/anything that needed focused vision to able to do all of it. When we started he couldn't follow anything with his eyes for more than a second. He can follow small things now for long periods of time. It has been amazing.

Andrew wasn't facing the same physical issues but his doctor told us he was the worst he had ever treated in terms of convergence and tracking. I was totally committed to doing our homework. It was hard--really hard at first. But it made a huge difference here. If you're working with someone reputable I think it's well worth it. Can you get references from the dr. and talk to other patients whose children had similar issues? Their experiences might help you make up your mind.

side note: your opth. opinions aren't held by all. Andrew was evaluated by a pediatric opth. (well respected in Indiana--huge center) who told us it wasn't his area of knowledge but that we might want to look into vision processing with him.

[anj_rn]

We are getting vision therapy through the school district. Our neuro opthamologist said there was no data to prove that it was beneficial, but it would not hurt, so we should do it.

[Old Raisin]

Vision Therapy is worth it.

I practiced vision therapy for 25 years. Just so you know, old Ophthalmoligists hate Optometrists. It's not about who is right or wrong or what is in the patient's best interest. It's about power and greed. Vision Therapy is practiced by Optometrists who have been tested for competancy by the COVD, College of Vision Development. Vision is a learned skill and when the correct stimulus is given for the learning to occur, it can be developed. Of all the senses, vision is the most active receptor of information. If there are any deficits in a child's visual performance (Focusing, fusion, fixation and flexibility) then it should be addressed as a priority. Anyones' visual skills can be tweaked.

The lady who is getting vision therapy through the school district, you are amazingly lucky. I have never heard of that.

There is no actual way for the average person to know if their child is receiving quality vision therapy. Very often, an optometrist will hire someone at minimum wage and teach them to do various prescribed activities. The kids still benefit from the disapline. However, if it were my child in therapy, I would want a complete walk through of the childs activities on the first visit. I would want to see how my child does on the first day. (Taking Notes.) I would want to know what are the normal ranges on each activity. Then everyday, get a full accounting of how the child is progressing. Also, be aware, that these places often practice group therapy. And that works fine for the patients provided the therapists are not conducting personal conversations when the focus should be on your child. "Popping in" helps keep that to a minimum. Also, I have heard of Drs. charging for a certain number of visits up front. Never pay for visits in advance. Always get second objective opinions.

To the mom of the child with Nystagmus. As far as I know, there is no treatment for that. It is beyond the scope of my expertise as to whether it would be beneficial to treat the strabismus because of the presence of the Nystagmus. We have had a few Nystagmus patients that we have worked with to try to get their supporting skills tweaked but not a any did we treat for strabismus too. I have never heard of Nystagmus being resolved by the wearing of bifocal lenses. Yours is a tough call, I would consult more wise old raisins for a second and third opinion!

I hope this helps.
One Old Raisin

[LauraLoo]

We had great success with vision therapy. DS started when he was 7 years old for tracking, fixation, peripheral, & convergency issues. It made it difficult for him to read for any length of time, but also in navigating his entire world. He had been compensating a lot, and it was finally catching up to him. Therapy took about 6 months; initially we did therapy sessions every other week for the first 3 months because of the driving distance and then the last 3 or 4 months we did sessions every week. Within the first month, I could see a huge improvement with his ability to do the homework assignments, but it was really tough on ds initially. Like the other pp, we were diligent in doing all the homework therapy and never missed an appointment.

I sat in for everything - the assessments and all of the therapy sessions, and I was encouraged to do so. Because of this, I was able to see where ds was struggling and what the therapy was intended to correct or strengthen.

We had a follow up session & assessment last January which was 6 months after ds completed therapy to make sure that everything was as it should be and we have another assessment next January. We are no longer doing daily therapy homework, but once in awhile, we'll pull something out just to practice.

I am really amazed at how much VT really helped my ds. I wasn't anticipating that it would be as beneficial as it was. Our insurance didn't cover a dime, but VT was worth every single penny we paid and every minute of time spent driving to appointments and doing the homework.

[naismama]

We started vision therapy in January with our 4 yo daughter, and we stopped after 4 months. Our dd was born with esotropia (inward eye turn) and had nystagmus until after her first surgery at 1 yo. She also had surgery at 2 yo. The surgeries significantly lessened the eye turn, but did not correct it completely. We had looked into vision therapy before any surgeries, but after a lot of research and visits with different doctors and therapists, we decided to do surgery.

After the second surgery, the pediatric opthlamologist put dd in bifocals. We felt that he was getting too aggressive with the prescription, so we decided then would be a good time to start seeing a developmental optometrist. We were happy with the optometrist's approach and eventually followed his suggestion that dd begin vision therapy.

For the first few weeks it seemed like a monumental waste of money. It might sound really horrible to look at something as precious as your child's vision in terms of dollars and cents, but we were paying over $100 dollars per 35-40 minute session for our child to do snow angels in the floor, do jumping jacks on a trampoline, and walk back and forth on a slide board while the therapist asked her questions relating to her peripheral vision and orientation ("how did you know you came to the end of the board?"). The therapists and developmental optometrist (not ours but another one in the practice that seems more gung ho on the therapy) scoffed at the idea that some of the other things dd was doing in her everyday life, might provide some of the same practice with spatial orientation and balance--gymnastics, for example. Gymnastics, other sports, and play in general are fine, they say, but they do not have the visual component. They also distilled any and all of my daughter's behavioral problems down to having strabismus. My husband and I eventually came to the decision that we didn't buy it.

So much of what they focused on was gross motor skills--but here is the problem: our daughter has pretty good motor skills. She has terrific balance, can throw and catch a ball, and can ride a bicycle--no training wheels-- like a champ at 4 yo. What she couldn't do so much, is exhibit the focus and maturity to do the required sessions at home. She'd roll around, play, refuse to cooperate--you know, all the things 4yo's do. And without follow-up and consistency at home with the exercises, there is only so much 40 minutes a week is going to do. And it can be difficult to measure--especially with a kid so young--how well the therapy is working, or whether it is working at all. The only thing I could be sure of week to week was whether she was getting better at doing the exercises.

Now, when we went to therapy sessions, there was a 7 yo boy in there. His sessions made sense to me. He was doing lots of work with tracking and eye control. I wished my daughter could have done that kind of work, but she is just too young to follow complex directions and give the kind of feedback it requires. DH and I will consider putting her back in therapy in a couple of years. For now, we're putting our money toward private school and activities for dd that will stimulate her visually and in other ways! She is still in the bifocals and doing fine with them. She even reads (although they tried to get me to stop that, it's easier said than done) and seems to do fine.

I'm sure you'll get plenty of replies from posters for whom vision therapy really helped their lo's. And that's great and truly wonderful. This is just my family's experience. I think it makes a difference that my daughter has a visual problem that has been present from birth. I don't know if children in that situation get the same degree of help and improvement from VT as kids who start experiencing problems later. Even with their decades of experience and hundreds of patients, the doctors in that office saw much, much more of the latter type of child, not so much of the former.

Best wishes on your journey...please pm me if you have questions or just want to talk.

--naismama

[goldfinches]

My sister is a vision therapist. She's seen many children helped through her work. Some not, I guess it depends on their diagnosis, age, parental involvement, etc.

She doesn't mind parents sitting in, unless it distracts the children. She does mind the "popping in". It is very distracting to the children.

I'm not sure if 3.5 years is old enough, but your therapist could probably give you an honest answer about that.

[dmaino]

As a Professor of Pediatrics and Binocular Vision at the Illinois Eye Institute/Illinois College of Optometry and a private practitioner who specializes in this area, I find the one doctor's statement about not believing in vision therapy...well, unbelievable! There are several National Institutes of Health National Eye Institute supported studies that show vision therapy works (lots of other research as well). It works for amblyopia (patching, wearing glasses alone does quite a bit) and certainly for binocular vision disorders such as convergence insufficiency (a problem with eye teaming). Now not knowing the full diagnosis of your little one, it is hard to predict how much success you will have with optometric vision therapy. The nystagmus may be an indication of other issues that should be investigated as well and may alter the success you might have with any form of treatment. Please feel free to email me at [e-mail] if you have any other questions that you think I might be able to help you with...also, my blog at http://www.MainosMemos.blogspot.com could help you find some answers as well. I post current research there concerning children's eye problems. You might want to type amblyopia into the search box to see what pops up in this area. Good luck! Dominick M. Maino, OD, MEd, FAAO, FCOVD-A

[dmaino]

Your neuro OMD needs to keep up with the current research literature...he should at least direct you to resources to find out the answers.. Why did he suggest doing it if it was not beneficial? Strange. DM

 

Originally Posted by anj_rn 

We are getting vision therapy through the school district. Our neuro opthamologist said there was no data to prove that it was beneficial, but it would not hurt, so we should do it.

[dmaino]

Just remember no two doctors practice exactly alike...so seeking out a second or even 3rd opinion...or approach....is sometimes warranted. I would suggest you go to http://www.COVD.org to find an approach more suited to you and your family. DM

 

Originally Posted by naismama 

We started vision therapy in January with our 4 yo daughter, and we stopped after 4 months. Our dd was born with esotropia (inward eye turn) and had nystagmus until after her first surgery at 1 yo. She also had surgery at 2 yo. The surgeries significantly lessened the eye turn, but did not correct it completely. We had looked into vision therapy before any surgeries, but after a lot of research and visits with different doctors and therapists, we decided to do surgery.

After the second surgery, the pediatric opthlamologist put dd in bifocals. We felt that he was getting too aggressive with the prescription, so we decided then would be a good time to start seeing a developmental optometrist. We were happy with the optometrist's approach and eventually followed his suggestion that dd begin vision therapy.

For the first few weeks it seemed like a monumental waste of money. It might sound really horrible to look at something as precious as your child's vision in terms of dollars and cents, but we were paying over $100 dollars per 35-40 minute session for our child to do snow angels in the floor, do jumping jacks on a trampoline, and walk back and forth on a slide board while the therapist asked her questions relating to her peripheral vision and orientation ("how did you know you came to the end of the board?"). The therapists and developmental optometrist (not ours but another one in the practice that seems more gung ho on the therapy) scoffed at the idea that some of the other things dd was doing in her everyday life, might provide some of the same practice with spatial orientation and balance--gymnastics, for example. Gymnastics, other sports, and play in general are fine, they say, but they do not have the visual component. They also distilled any and all of my daughter's behavioral problems down to having strabismus. My husband and I eventually came to the decision that we didn't buy it.

So much of what they focused on was gross motor skills--but here is the problem: our daughter has pretty good motor skills. She has terrific balance, can throw and catch a ball, and can ride a bicycle--no training wheels-- like a champ at 4 yo. What she couldn't do so much, is exhibit the focus and maturity to do the required sessions at home. She'd roll around, play, refuse to cooperate--you know, all the things 4yo's do. And without follow-up and consistency at home with the exercises, there is only so much 40 minutes a week is going to do. And it can be difficult to measure--especially with a kid so young--how well the therapy is working, or whether it is working at all. The only thing I could be sure of week to week was whether she was getting better at doing the exercises.

Now, when we went to therapy sessions, there was a 7 yo boy in there. His sessions made sense to me. He was doing lots of work with tracking and eye control. I wished my daughter could have done that kind of work, but she is just too young to follow complex directions and give the kind of feedback it requires. DH and I will consider putting her back in therapy in a couple of years. For now, we're putting our money toward private school and activities for dd that will stimulate her visually and in other ways! She is still in the bifocals and doing fine with them. She even reads (although they tried to get me to stop that, it's easier said than done) and seems to do fine.

I'm sure you'll get plenty of replies from posters for whom vision therapy really helped their lo's. And that's great and truly wonderful. This is just my family's experience. I think it makes a difference that my daughter has a visual problem that has been present from birth. I don't know if children in that situation get the same degree of help and improvement from VT as kids who start experiencing problems later. Even with their decades of experience and hundreds of patients, the doctors in that office saw much, much more of the latter type of child, not so much of the former.

Best wishes on your journey...please pm me if you have questions or just want to talk.

--naismama

[Fay]

We had limited gains with vision therapy.  Our insurance did not pay a dime for it.  DS1's dx is autism, so he had some difficulty tracking & interpreting what he saw.  The optometrist said we would reach all goals in 6 months, and if DS1 needed more therapy than that, we would not have to pay for it.  It went for almost 10 months, and DS1 could not progress due to cognitive limitations.  It was very frustrating: the optometrist was saying that he had met his goals, but we had only seen very modest gains complicated by a whole new level of behavior problems at home.  However, he is reading more fluently now, although comprehension is low.  He was 8 years old at the time of vision therapy.

With vision therapy, there is homework every night.  You are basically retraining the eye muscles, and that takes some effort every day.

Because of the cognitive component, our optometrist recommended vision therapy only after age 5.  At age 3, you're probably better off with games and activities at home that require visual motor control.  Just my 2 cents.

[beenmum]

We use CNIB and its free. Maybe try your local chaper of vision services instead of going through that therapist.

[rhianna813]

I had strabismus and was diagnosed around age 5, back in the early 70’s! I did vision therapy but it was just at home with patching, distance focusing on objects and tracing exercises. I am sure it is nothing like what they do these days. Eye muscle surgery was offered but we didn’t go that route.

My eye moves out to the side and my biggest symptom was double vision. When I could hold my eye in normal, I would see normal. My eye would turn out easily, especially when not focused on a task. I tried Prism lenses in my 20’s but they didn’t help at all.

Fast forward to me age 35. My strabismus got much worse and started causing depth perception issues. I went to a great doctor and decided on surgery. It was life changing. Mine was not able to be fixed 100% but it feels like it was. I see great now.

Except…. That I also have an inner ear issue. And through Vestibular Therapy we realized that I get nystagmus and my eyes do not always work together. I still have very subtle depth perception issues and something called Convergence Insufficiency. My eyes and inner ear do not play well together sometimes.

Through my Vestibular Therapy (which is oddly covered by insurance) we do some forms of Vision Therapy, which is very helpful to me!! I do Gaze Stabilization exercises and use a machine in his office that uses blue/red lights, with some 3D glasses.

As my eyes strengthened and started working together more, my instances of dizziness decreased.

As other’s have mentioned I am not sure a very young child could do these exercises, but I think they can work. I also think eye muscle surgery is a great option if available.

Rhianna

[anj_rn]

My daughter suffers from disconjugate gaze and CVI (Cortical Visual Impairment) as a result from a near SIDS event at 4 months of age.  The reason that she was not sure how beneficial the therapy would be is that the problem with the vision is a result of the brain injury, nit the eyes themselves.  There is no conclusive research on the benefits of vision therapy with CVI.  Her attitude was more that she was not sure it would help, but it could not hurt.  We see a lot of therapists, and a lot of specialists.  I think our neuro-opth was trying to let us know the service was available, be honest about outcomes, and make sure we did not feel compelled to do the therapy if we were overwhelmed with our other therapy appointments.

Quote:

Originally Posted by dmaino 

Your neuro OMD needs to keep up with the current research literature...he should at least direct you to resources to find out the answers.. Why did he suggest doing it if it was not beneficial? Strange. DM

 

[lshawmcminn]

Originally Posted by naismama 

We started vision therapy in January with our 4 yo daughter, and we stopped after 4 months. Our dd was born with esotropia (inward eye turn) and had nystagmus until after her first surgery at 1 yo. She also had surgery at 2 yo. The surgeries significantly lessened the eye turn, but did not correct it completely. We had looked into vision therapy before any surgeries, but after a lot of research and visits with different doctors and therapists, we decided to do surgery.

After the second surgery, the pediatric opthlamologist put dd in bifocals. We felt that he was getting too aggressive with the prescription, so we decided then would be a good time to start seeing a developmental optometrist. We were happy with the optometrist's approach and eventually followed his suggestion that dd begin vision therapy.

For the first few weeks it seemed like a monumental waste of money. It might sound really horrible to look at something as precious as your child's vision in terms of dollars and cents, but we were paying over $100 dollars per 35-40 minute session for our child to do snow angels in the floor, do jumping jacks on a trampoline, and walk back and forth on a slide board while the therapist asked her questions relating to her peripheral vision and orientation ("how did you know you came to the end of the board?"). The therapists and developmental optometrist (not ours but another one in the practice that seems more gung ho on the therapy) scoffed at the idea that some of the other things dd was doing in her everyday life, might provide some of the same practice with spatial orientation and balance--gymnastics, for example. Gymnastics, other sports, and play in general are fine, they say, but they do not have the visual component. They also distilled any and all of my daughter's behavioral problems down to having strabismus. My husband and I eventually came to the decision that we didn't buy it.

So much of what they focused on was gross motor skills--but here is the problem: our daughter has pretty good motor skills. She has terrific balance, can throw and catch a ball, and can ride a bicycle--no training wheels-- like a champ at 4 yo. What she couldn't do so much, is exhibit the focus and maturity to do the required sessions at home. She'd roll around, play, refuse to cooperate--you know, all the things 4yo's do. And without follow-up and consistency at home with the exercises, there is only so much 40 minutes a week is going to do. And it can be difficult to measure--especially with a kid so young--how well the therapy is working, or whether it is working at all. The only thing I could be sure of week to week was whether she was getting better at doing the exercises.

Now, when we went to therapy sessions, there was a 7 yo boy in there. His sessions made sense to me. He was doing lots of work with tracking and eye control. I wished my daughter could have done that kind of work, but she is just too young to follow complex directions and give the kind of feedback it requires. DH and I will consider putting her back in therapy in a couple of years. For now, we're putting our money toward private school and activities for dd that will stimulate her visually and in other ways! She is still in the bifocals and doing fine with them. She even reads (although they tried to get me to stop that, it's easier said than done) and seems to do fine.

I'm sure you'll get plenty of replies from posters for whom vision therapy really helped their lo's. And that's great and truly wonderful. This is just my family's experience. I think it makes a difference that my daughter has a visual problem that has been present from birth. I don't know if children in that situation get the same degree of help and improvement from VT as kids who start experiencing problems later. Even with their decades of experience and hundreds of patients, the doctors in that office saw much, much more of the latter type of child, not so much of the former.

Best wishes on your journey...please pm me if you have questions or just want to talk.

--naismama

Hi Naismama,

Some time has passed but I hope this finds you.  I am a student at the Southern California College of Optometry.  Your concerns about your daughter not receiving the same bang for her buck as a 7 year old would is very valid.  Children progress through VT fastest once they hit 5-7 years old.  However, if a child is falling behind at age 4 it may be best to start that early, depending on what their condition is.  Given that 2 years have passed since your post I hope you consider trying VT again.

However:  At my school we are taught around 100 different exercises and many variations on each to be applied to different children depending on their particular condition.  There are several variables associated with esotropia, for instance, that your doctors may not have mentioned or may not have felt necessary to check before treatment.  For this reason, the activities that another child is doing in VT should not be compared directly to your child since their situation is probably very different.

At my school, therapy costs $80 an hour, and the child gets 45 minutes with 2 interns and 15 with a doctor.  Some optometrists hire or train therapists so it is important to ask about the therapists qualifications and perhaps even their pay.

There are many studies that show vision therapy works; myths that say otherwise are far long debunked.  Depending on the situation it will also work much better than other treatment.  Depending on your child you may need congruent treatment with an occupational therapist, physical therapist, psychologist, or ophthalmologist (and a gymnastics teacher of course!).