Vision Therapy research?

[NCW]

Our children have been receiving OT treatment for dyslexia/dysgraphia, and some sensory processing issues, since August. The OTs think they may benefit from vision therapy, or that at least that a developmental vision eval is warranted. I agree, but since it's hugely expensive ($2,000 for 10 hours was the quote I received, plus the cost of the eval), my dh would like to see some research that this is effective and that our kids really need it. That's understandable. He wonders if it's an effective treatment technique why insurance doesn't cover it. Hmmm....

Can anyone point me to some current research? I'd really appreciate it.

NCW

[Rod Everson]

My website, OnTrack Reading (http://ontrackreading.com) (ontrackreading.com) has a page discussing a study done on Convergence Insufficiency which is one of the common vision skill issues that can lead to reading problems. You can get to the page with this link, Convergence Insufficiency Study (http://ontrackreading.com/the-vision-piece/convergence-insufficiency-study), and on that page you'll find a link to the study itself. Further down on my page you'll also find links to relevant graphs within the study.

Also on my site, you'll find an extensive discussion on why I recommend that any parent who has a child struggling with reading should consider having their vision evaluated by a developmental optometrist. It's a huge issue that is overlooked way too often, in my opinion.

Hope this helps,

Rod Everson

[kRenee]

I wonder why insurance doesn't cover it also.

After my experiences, I think every child should get a develpmental vision evaluation. My ds is doing vision therapy now. He knew how to read. He could read, but just said he didn't like it. Now I know it was vision related.

I talked to two different dev. optometrists in my area and they had very different approaches. One would accept the recent exam results from our regular optometrist, whereas the other one would not. There were differences, too, in whether all the tests were done up front, or whether some were delayed. So the initial cost was $125 vs $400. Call around, you may find a similar difference.

[Alexandra]

It seems that the ONLY place that one can find VT is with an optometrist. Why, if it is so effective, does the medical community (on the whole) not offer or endorse this intervention?
Not meaning to hijack here...
Alexandra

[NCW]

Thanks for the link, Ron. I also appreciated looking over your site. I printed the article to read.

This has been a puzzling journey - my dd had a tough time learning to read in first grade (I taught her, but I was a dragon momma then). I used Phonics Pathways, because I knew dyslexia ran in dh's family and the WTM recommended it. She continued to have letter reversals, hated workbook pages, and fell to the floor whining when asked to write or copy a sentence. I took both of our children to a developmental optometrist when she was 8 and our son 6. Report? "Minor" problems with focusing for dd - not significant enough to treat - and no problems for my son. Since then I've realized it was probably not a thorough eval, but they were the only place to go in town at the time and I had no reason to think otherwise. Our son wears bifocals now because of slow near-far accommodation.

I spent a few years wondering why homeschooling was such a struggle for me, when everyone else was done in a few hours a day with their same-age kiddos. Ha!

Years later, they both have formal dyslexia/dysgraphia diagnosis, which has allowed us to get OT treatment. I've also taken them to a craniosacral therapist, who said ds's sphenoid bone was torqued two different ways (both of them related to reading problems). Straightening it out made a HUGE difference - he actually enjoyed reading for the first time...and has been reading slowly but steadily ever since. Dd hasn't had her sphenoid checked yet - it's been a $$ flow thing, but we're getting to it!

So this vision eval is just the next step in trying to provide one more stepping stone. I know they're going to recommend therapy, and I think dh knows it too, and we're both quaking at the expense. It doesn't help that the clinic is 75 minutes away. I think dh just has to know it will be worth the cost.

And, I admit, most of the time my spouse and I go around in denial...especially regarding dd, who is a voracious reader (believe it or not). Yet figuring out forms, like worksheets, and some other things still pose problems. And there's that dysgraphia thing, and taking notes, and and and...

Thanks for listening to my story. Just needed to dump it out there today, I guess.

I've read so many books on dyslexia, teaching reading, and sensory processing issues that the thought of tutoring one day keeps crossing my mind...

NCW

[Rod Everson]

Regarding the insurance issue: According to the VT department I'm familiar with, if vision therapy is covered at all, it's under medical insurance, not vision insurance. The odds of it being at least partially covered are probably around 50/50, according to the VT dept. It also probably depends a lot on what state you live in, as some states mandate far more coverages than others do.

As to why other eye care professionals don't also open VT departments, they probably will as the demand grows. And demand is growing, I believe, because the internet makes it far easier to disseminate useful information than used to be the case.

Rod

[Claire]

Can anyone point me to some current research? I'd really appreciate it.NCW

The informational website I really like is Children's Vision (http://www.childrensvision.com). This is a good place to get general information about the types of vision problems that are not tested in regular eye exams.

Here is a link to their list of research studies (http://www.childrensvision.com/research.htm). Here is another list of research studies (http://www.visiontherapy.org/vision-therapy/vision-therapy-studies.html)online.

Regarding VT costs, I strongly recommend checking around before committing to a specific developmental optometrist. Have you checked the list of optometrists at the board-certification website (http://www.covd.org)? If not, run a search there to see who is in your area. Call or email each office to get a feel for how they conduct business. Many developmental optometrists are willing to design primarily home-based programs of VT to keep costs down, but some insist on only in-office therapy. (This may not be all their fault. Some optometrists get tired of parents who do not do the therapy exercises at home as scheduled.) All in-office therapy is the most expensive way to do it. VT is not rocket science, and usually many of the exercises can be done at home if you are taught what to do.

Also, several of the most common visual efficiency problems respond well to home computer vision therapy. Check this website (http://www.homevisiontherapy.com)for optometrists licensed to dispense the software. Cost for pre-testing, the software, and post-testing is usually under $300 total.

Check your medical insurance under the major medical section also. I have heard that vision therapy is covered under major medical unless specifically excluded (but that is only hearsay!). Some medical insurance policies do cover vision therapy. I know that one Blue Cross Blue Shield policy that was posted online specficially mentioned vision therapy being covered. Most people look for this coverage under the vision section of their policy, but they should be looking under major medical.

[Claire]

It seems that the ONLY place that one can find VT is with an optometrist. Why, if it is so effective, does the medical community (on the whole) not offer or endorse this intervention?

I'd say that most medical doctors don't know anything about vision therapy.

Opthalmologists never endorsed VT because the field was developed by optometrists. In fact, they came out rabidly anti-VT in the early days, claiming it was quackery. When independent research demonstrated conclusively that VT is effective for convergence and accommodation issues, the U.S. Assoc. of Opthalmologists created a subspecialty called "orthoptics". Orthoptics is the subset of tests and exercises originally developed by optometrists. However, on orthoptics websites you will never see any reference to optometrists or to "vision therapy". Orthoptics is described as "muscle retraining" instead of vision therapy.

The American Assoc. of Pediatricians also did a dis-service to VT when they came out with a strong position statement saying something to the effect that vision therapy did not cure reading problems. (This was about 20 years ago, I think.) Well, duh.... VT corrects vision problems.

There's a whole history to VT in this country which is convoluted and not very nice. VT has been widely practiced in Europe for many years without all of the controversy it has had here.

[Kathy in MD]

This typically includes eye exams, contacts and glasses. Vision therapy is often denied because it's considered part of the excluded eye care. However, some dev. vision problems are conventionally corrected by surgery. Typically this eye surgery is covered under major medical. And because VT has a higher success rate combined with typically lower costs (per my ds's dev opt.), most insurance companies that cover eye surgery will cover VT.

[NCW]

I just want to thank everyone for the info and links. I am checking this out, and have checked with our insurance company (who actually won't decide on coverage until after the initial eval results...there's some hope there, after all). You know, it was one of the two area providers who told me that insurance doesn't cover it at all. The other one does what they can to work with insurance providers, even though you have to pay cash up front for all services.

Anyway, the initial eye exams are scheduled for both kids on the 27th of this month. At that time they'll determine whether they need the full, longer eval for vt.

Thanks again, also just for listening and support. I was a tad stressed there for a couple of days.

NCW

[Claire]

IYou know, it was one of the two area providers who told me that insurance doesn't cover it at all. The other one does what they can to work with insurance providers, even though you have to pay cash up front for all services.NCW

It's only recently that more and more insurance companies have started covering VT. When we did it, 8 years ago, there was no medical insurance coverage for it at all. Also, some small clinics cannot afford to hire a medical insurance specialist to help with insurance claims. Years ago VT was adamantly rejected for insurance coverage, so that one provider may simply not have kept up with the changes in recent years.

[kfrench]

My older daughter had VT for 9 months. Insurance covered half. Now they no longer cover it. Well she did pick up her reading speed but a year later she is having problems again and they want her to do 12 1/2 hour sessions at $1000 So I did see alot of improvement with VT but it did not cure her it is a long term thing. She still reads behind grade level and changes words. She does not reverse letters anymore and most of the time doesn't read words backwards. She was obviously in pain when she was reading before VT , once I realized the problem with not being able to read was her eyes. She would glance up after each word and I thought she was ADD she was so hyperactive during school but it was just avoidance of reading and writing because it strained her eye's so much. She didn't know her eye's were not suppose to jump around so she just thought reading was really hard. So it did help alot but I would be careful to get long term eye exercise plan when you reach the end of your session because we didn't. My fault and it looks like I will pay big for it. Now I am getting ready to take my 2nd daughter. She is so different from her sister but still struggles with reading allthough she loves it and enjoys it she can only read 20-30 words a minute. She also reverses her letters all the time and even will reverse the S in her name. She also says was and saw backwards and on and no. So I guess we will pay even more for her.
The doctor requires full payment ahead of time. I talked to the school nurse because they are having other testing also because of the reading difficulty and she said that some parents said VT helped alot and many said it only helped a little. It probably depends on the severity of the VT issues, how many sessions of VT and the doctor and follow up exercises. Also the vt said that often kids will have to take more VT when they go through puberty at age 13-14 because their eye's change or something. I think sometimes parents give up on VT too soon and so they don't see the progress. My dd had very slow progress for 6 months and then it finally clicked and her progress improved rapidly after that. She went from sounding out each word to reading quickly and she stopped reversing letters and words. She still has trouble sounding out big words but I think that is because she has other learning difficulties. Dyslexia or something yet to be diagnosed. Also kids have to build up their eye muscles and edurance with their newly learned skills so if you require a quick increase of to much reading and their eye's get fatigued they will go back to their old coping mechanisms. I think that is what happened to my daughter going from not much reading in HS to reading all day at PS.
I'm still trying to convince my husband to do some more VT but it might be a while. At this rate it might be this summer.

Kris

[Claire]

Did you ever get a written report of test results from the vision evaluation? Those test results would be very helpful here.

Have you checked the board-certification website (http://www.covd.org)to see if there are other qualified developmental optometrists in your area? As mentioned elsewhere on this board, often vision therapy exercises can be done at home. Many developmental optometrists are willing to design primarily home-based programs of VT to keep costs down, but you have to ask.

Another option is computer software used at home. The website (http://www.homevisiontherapy.com) lists optometrists licensed to dispense the software. Cost for pre-testing, the software, and post-testing is usually under $300 total. This software does not address all problems, but is good for some of the most common problems.

I honestly have not heard of a child needing to go back for more VT because of regression (or puberty). Your doctor also sounds as if he charges top dollar for therapy. I would look around to see if you can find another doctor in your area.

Also, VT is not enough for many children. We saw some gains from VT with my dd's reading, but it was not enough for fluency. We needed to follow up with cognitive skills training to develop reading fluency. We did PACE (http://www.processingskills.com) after VT. Prior to beginning PACE, my dd read Berenstain Bear books with extreme disfluency. About halfway through the 12-week PACE program my dh and I thought we were seeing a little improvement in dd's reading. At the end of PACE, my dd was reading out loud fluently from the first Harry Potter book. Many children do not realize the full benefits of VT until they follow up with cognitive skills training.