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Discussion Starter · #1 ·
About a year ago I posted here, very upset, about my under achieving daughter in 2nd grade who had recently been identified as gifted but was getting terrible grades, had issues with reading and writing, with school psychologist suggesting she had ADD.

A couple of people suggested getting her evaluated by a developmental optometrist, which I did, and it was determined she had a mid-line jump, slow focusing, and various other visual processing issues that I can't name.

I'm posting to share our great experience with vision therapy, because it has changed my daughter's life so much. I was really nervous about spending the $1400 to get her the therapy as it is so controversial, but it's really some of the best money I've ever spent.

DD finished her vision therapy in early September, after about 6 months of bi-weekly therapy sessions. She had 15-30 minutes a day of home exercises. The first thing we noticed was that DD's drawing went from about normal for her age (or maybe a bit below even) to more of a middle school level. This happened almost overnight after maybe 3 months of therapy, and was pretty shocking for me and DH. The mid-line jump disappeared a little after this time.

Around October she discovered graphic novels at the school library, and started reading them constantly. This was a kid that pretty much refused to read for pleasure prior to this, so I was thrilled that she was reading on her own. She started with graphic novels at her grade level and quickly moved up to the teen level. I bought her quite a few for Christmas but she read them all within the first week, then complained she had nothing to read. I handed her "Logicomix", a graphic novel of mine about Bertrand Russell and other great logicians (a graphic novel for adults), and she read it and loved it. She then moved on to regular books and spends lots of time reading now, with no prompting from anyone. I am absolutely amazed at this change, and so thrilled.

We just got her first-semester report card, and it is a HUGE improvement from last year. She is still getting horrible marks in German spelling (she goes to a German immersion school), but her English spelling is much, much better than it had been. Her writing is still a bit below grade level, but has improved a lot since last year. She still is not finishing her class work all the time, but it's not a huge problem like it was last year. She is also participating in class a lot more, especially in German week.

I will allow that there may be other factors at work here besides the vision therapy, but as there have been no other big changes I feel pretty comfortable saying that most of the changes are attributable to that. I'm pregnant with my third child now, and definitely plan on having her evaluated by a developmental optometrist in early childhood, and I recommend the same to everyone I know with small children. This has been such a life changer for us, and I hope the MDC posters who recommended it to me read this and accept my thanks!
 

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What a great update! Hopefully, the medical providers and insurance companies will start to track the positive results this kind of therapy is having for kids and make it more available.
 

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We also had a huge improvement with vision therapy -- ds hasn't officially matriculated out of it yet, and we have a yearly follow up in 2 weeks. Ironically, 2 years prior to doing VT, a pediatric neuropsych thought that ds suffered from severe ADHD because he flipped out doing some of the visual tracking - whack a mole kind of testing - that ds wasn't able to do with any type of accuracy. ADHD was ruled out by evals done at the school (he was in K at the time,) and we recently went through more testing where ADHD was completely ruled out.

ETA: dd has an appointment with a dev. optometrist in March -- not because we suspect anything, but because we don't want her to have to compensate (if she is) like ds did for so many years if there is an undiagnosed issue. I agree -- a thorough eye exam is always a good thing.
 

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I'm glad it's worked out so well!

I can't find the reference online, but there was a meta-analysis done on VT and the only thing it's clinically demonstrated to improve is strabismus/convergence insufficiency. DS has CI and we in fact have not done vision therapy due to it being cost prohibitive where I am (over $100/hour). We do see a developmental optometrist and do some exercises at home very sporadically. DS is eight and seems to have largely overcome it. We have focused our funds and efforts in other strategies with DS. I was very leery of a process where I couldn't expect to see change until I'd invested over $1,100 at the earliest.

I'm one of the first people to recommend seeing a dev opt to determine if vision might be at play for a kid who's struggling, but just wanted to share a caution about vision therapy as it is so expensive. I have no doubt that it works for some kids, but it's a bit of a growth industry without a lot of clinically demonstrated efficacy beyond the field itself.
 

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I am happy to hear about your child's success in vision therapy. I am a developmental optometrist in the Washington DC metro area, and I would like to comment to the poster who suggested that thousands of dollars would be spent before any changes are noted.

In my clinical experience, children will usually make significant improvements within the first month of weekly vision therapy, provided they are doing the 15-20 minutes of daily home practice we prescribe. It does usually take three to six months for the therapy to be complete, and for the new visual skills learned to "stick". With patients who have complicated visual problems, difficulty with compliance, or special needs, therapy can take much longer than six months.

Research on the efficacy of vision therapy goes well beyond just convergence insufficiency, and well beyond just the optometric literature. COVD (The College of Optometrists in Visual Development) has compiled a database of research, which can be found HERE. From the COVD website:

"This paper presents over 350 abstracts from 77 different journals within education, optometry,
ophthalmology, neurology and psychology fields of study. All works found relating to vision and learning
are included - even those that purport to show little to no relationship between vision and learning. Of the
many summaries related to vision and learning reviewed here, only fifteen (15) concluded that vision was
not related to learning. This strongly supports COVD's view that vision and learning are indeed intimately
interconnected."

I hope this information is useful to parents considering vision therapy. It is certainly in the best interest of all children to give them the proper tools, so they have the best opportunities to learn and succeed. Many times children will not complain of vision problems, because they assume everybody else sees as they do. The American Optometric Association recommends that a child's first eye examination take place at six months of age, even when there are no red flags. Early intervention can prevent many many vision problems, and in fact the AOA has developed InfantSEE, a free program of infant eye examinations. Children without risk factors should have additional examinations at three years, before first grade, then every two years after that.

I wish all of you a lifetime of healthy vision.

Amanda Zeller Manley, O.D.

www.VCDCwashington.com
 

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Dr Manley, I dug out the paper I refered to and looked at the information you supplied. I was too brief in my commentary on VT and I'll change my remark to state that I think parents should approach a very expensive and time consuming therapy regime with caution.

My son sees a dev opt and an ophthalmologist. The dev opt wants me to sign up for VT at $440 per month, and anticipates that we would see improvements in 10 weeks - that's $1100. That we would initially see some improvement, but that it would take months of work potentially to see significant improvement. In my little corner of the world, that's a lot of money on a "hopefully." And the whole "improvement" thing is too vague for me - I want functionality. The ophthalmologist has recommended at-home exercises as he doesn't see that in-office therapy will have better efficacy, and we'll go in for check-ins to mark progress.

I'm not slighting developmental optometry (we use this for both kids), or vision therapy. I'm cautioning parents who are looking to help their kids to be cautious and have their eyes open when they pursue a very expensive modality that afaik is not covered by most insurance. I have a multiply-complicated kid and I can't spend his university fund on every therapy that "might" "improve" this or that thing he's struggling with.
 

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It's true that vision therapy is expensive, especially when it's not covered by insurance (as is often the case). Which is ridiculous, but that's a whole other conversation. And it is time-consuming, I do not dispute you on that. We have many families who are not able to dedicate the time required to eliminate the convergence insufficiency (or whatever the problem). You get out of it what you put in, just like speech therapy, occupational therapy, tutoring, soccer or violin lessons.... It's a matter of priorities. I think that's why we have relatively few adult patients in vision therapy. They've managed the way they are as long as they have, and the motivation to change (even for the better) isn't there unless it's getting in the way with work or a preferred hobby.

I also agree with you completely that when a child has multiple issues, vision might not be the area most in need, so parents shouldn't make it the #1 priority. We frequently send patients to deal with speech, or OT, or psychotherapy issues prior to doing vision therapy. It depends on the child.

And a home program can be effective, when the prescribed activities are actually done. Just like some folks can work out once with a trainer and are diligent about working on their own after that. But in most cases (and this is documented in the CITT study published in the Archives of Ophthalmology), in-office vision therapy is much more effective than home-based therapy. I can tell you that in my practice, the patients with CI who have not "improved"-- by which I mean obtaining normal results on levels of convergence, fusion, and stereopsis combined with an elimination of symptoms such as double vision, skipping words when reading, words moving on the page, headaches-- are the ones who missed prescribed sessions and/or did not do the prescribed homework. I've never had a CI patient who followed the prescription and didn't get better. So going back to my earlier point, you get out what you put in. And for folks who can't make the time and effort, I would suggest not "wasting" their money on vision therapy. I'm with you 100% on that.

-AZM
 

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Discussion Starter · #9 ·
EyeDocAZM- this is pretty much what our optometrist told us. He was very confident that we would see good results because my daughter was very motivated and took it into her own hands to do the exercises so she would be able to see better, and we were not disappointed, obviously. I think doing daily exercises is really crucial, and we definitely saw results within a few weeks. It was hard to fork over the money, but as I said, I would do it again in a heartbeat and feel like it was money well spent.
 
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