Vision therapy for toddlers… an exercise in patience.

Stella, back in May, on her first day with glasses. (She was 20 months old.)

Stella, back in May, on her first day with glasses. (She was 20 months old.)

Hello! I’m Amber. Ann recently posted about Stella, my little “fashion visionary.” She honestly does love wearing that “pirate girl” onesie! Stella very recently turned two and, in addition to wearing glasses and patching three hours a day, is two weeks into vision therapy. I’d love to share our vision therapy stories and hear about your experiences, especially with vision therapy for very young kids as it seems to present unique challenges.

First, let me explain how our path led to vision therapy. Treatment for her vision issues (first, accommodative esotropia and now ambylopia) began in April in the ER at Seattle Children’s Hospital. She’d been sick with a bad cold and had lost about a pound, and that morning I thought she’d bumped her head (saw it out of the corner of my eye–I wasn’t sure about anything but the screaming). That’s when both of her eyes suddenly started crossing–severely. Her pediatrician was visibly alarmed and sent us to the ER where they ruled out serious lie-threatening problems via head CT scan and tentatively diagnosed her with “convergence spasms.” A couple weeks later, we were routed to one of Children’s Hospital’s ophthalmologists. We now realize that the illness and stress must be what brought out Stella’s latent or, at the very least, hard to detect intermittent esotropia.  I wish the ER had been aware that this was actually a rather common presentation, so Stella could’ve avoided all that radiation. Hindsight is 20/20. Unlike Stella’s left eye. Ahem.

After a very thorough exam, the ophthalmologist prescribed glasses, which have helped a lot in keeping her eyes straight. Then, at the follow-up appointment, they told us to start patching as visual acuity was decreasing in her weaker eye (her left eye has a stronger prescription which, from what I gather, means she has anisometropia). They said she may need to patch for years, but never mentioned vision therapy, I suppose because most ophthalmologists not only don’t offer it but aren’t very familiar with or approving of it. After reading Fixing My Gaze, I became dissatisfied with this approach for Stella and was excited to explore the possibility of vision therapy. Our second opinion came from a developmental optometrist who told me that Stella was too young for vision therapy. Luckily, we sought out a third opinion from a developmental optometrist who, among other seemingly innovative suggestions that differed from what we’d heard elsewhere, said Stella could begin vision therapy at this age! We now go every Wednesday morning to play “eye games.” The vision therapy guidelines they gave us initially say that most courses of vision therapy span nine to 12 months. Our journey is just beginning.

Stella, being careful with her glasses.

Stella broke five pairs in the first two months, but she now carefully and proactively removes her glasses before engaging in furniture acrobatics.

One of the concerns–actually, it’s more of a mental conflict–I’ve had about vision therapy is in regards to Stella’s age. Susan Barry, in Fixing My Gaze, and other experts urge us parents of children with vision issues to begin treatment (be it patching, glasses and/or vision therapy) as early as possible. Yet, not only was Stella denied vision therapy at one developmental optometrist’s office due to her age, but I’ve been hard-pressed to find specific information or success stories about vision therapy at such an early age. All the wonderful, encouraging outcomes I read about seem to involve children between the ages of about five and 10 or so. The exercises are no doubt easier to execute at that age, including the seemingly more fancy, advanced activities that require a kind of sustained focus that Stella just can’t generate at this point. But the younger you are, the more elastic your brain, so not pursuing vision therapy early on feels like a missed opportunity.

To be honest, while Stella’s current, wonderful doctor always saw vision therapy as a part of Stella’s treatment plan (probably to begin after a couple more months of patching), I nudged her toward allowing Stella to start sooner. I’ve been torn between feeling excited about doing vision therapy right as she turns two, and nervous about whether it will be a waste of money, though the latter concern is being assuaged as we go. (Vision therapy is decidedly and painfully not covered by our insurance. It costs $125 a week, and we had to pay a one-time $50 fee for supplies that we’ll be borrowing for home-based vision therapy. Anyone need a good freelance copywriter? I sure could use the income. Yikes!)

She does well with the weekly in-office exercises, and seems excited upon arrival. They make the sessions fun and age-appropriate, so there’s lots of novelty and variety. At this early stage, all the activities are monocular so as to help the ambylopic eye get back up to speed (we keep the patch on during our visits), and then we’ll move to binocular exercises to get the eyes to work together. Last week, she was clapping bubbles, catching balloons, and riding a Sit N’ Spin–after three quick spins, a number puzzle piece was immediately held way off to the side of her head, so she had to turn to focus on it, say which number it was, then work to place the piece in the puzzle, all while her eyes recovered from dizziness. By the time we got to number nine, she was pretty much done. Today, she put little quills into tiny holes in the back of an adorable toy porcupine (of course it’s a toy–though the real thing would’ve been a total challenge, visually and otherwise). She also went fishing, which was a hit. This game required her to scan the room to find/identify the octopus, shark or other specific animal amid the gray sea of the office’s carpeted floor, carefully lower the magnet dangling from her little fishing pole onto the magnet centered on the animal, then deposit it in the container held by the therapist.

I’ll admit that so far, it’s been hard to do the vision exercises at home. Sometimes, impossible to the point of my wanting a glass of wine at 3pm. Stella’s attention span and patience are not only low due to her age, but because the activities we’re supposed to do are uncomfortable for her. Of course, that’s the point–to challenge her eyes and make them work harder and in ways that are currently outside her left eye’s relatively narrow comfort zone. For instance, we were supposed to play catch with the balloon for a bit each day, as we did in the office. But after a few days, she simply refused to even look at the balloon , no matter how hard I tried to entice her. Sadly, I found myself on my hands and knees, begging and pleading for a good ten minutes, and near tears at one point, to no avail. Pathetic image, I know. Even chocolate chips, previously very compelling rewards, no longer held any sway. Today, Stella’s vision therapist, who’s been wonderful about answering my questions via email, explained that Stella’s resistance is normal. It takes a while for little ones to go get with the program, much like the period of adjustment and gradual acceptance of glasses and patching. By providing a variety of fun activities and not forcing things too much, I hope that eventually, we can make home vision therapy an enjoyable and regular part of each day. The therapist asserted that the benefit of doing vision therapy at this age is that they respond so quickly, and noted that it’s very exciting and gratifying to see their progress unfold.

There are other benefits of vision therapy that I hadn’t really thought about or anticipated. For a worrywart like me, it’s reassuring to have a knowledgeable person (the vision therapist) keeping tabs on how Stella’s eyes are doing and getting familiar her visual capabilities while watching them change and evolve. Especially in the face of widely conflicting opinions from doctors, I’d felt like it was all on my shoulders to monitor the situation and to make sure all was well. Now I feel that I can relax a bit. Vision therapy is also an opportunity to get answers to questions, and I take over-the-top advantage of that. At the same time, the vision therapist can point out when Stella is showing the true capabilities and impairments of her weak eye and it helps me more clearly understand how Stella sees the world and what needs to change. I’m likely to chalk up any fine-motor-skill deficiency to Stella’s young age, when may really have more to do with her vision. A couple of times today during her appointment today, Stella aimed to the side of her target and then adjusted to hit it correctly the next time. The more times she does that, the therapist explains, the better. I can’t put it in technical terms as this point, but each time she successfully corrects her weak eye’s misjudgment, it helps Stella’s brain and eyes figure out how to more accurately see the world and judge spatial relations.

Aside from making me less neurotic and way more patient (sigh, I’m working on it), here is the true goal of Stella’s vision therapy, as stated in an email I received from the vision therapist:

This is a great opportunity for us to monitor and improve Stella’s vision before she encounters all the visual stress that school and daily life can bring.  The things I mentioned (such as including movement breaks rather than allowing extended near work without a break) are good ways we can keep Stella’s visual stress low right now while we work to improve her vision.  Starting VT [vision therapy] at such a young age allows us to prepare her vision and help her to become comfortable (and have stable vision) with different tasks–near, far, and everything in between.”

So, that’s our vision therapy experience so far. If anyone is interested, I’ll keep you posted on her vision therapy, and you can always read about what we’re up to, vision-wise and in general, at my blog at The Life and Times of Stella. It would also be great to hear about others’ experiences with vision therapy, at Stella’s or any age for that matter! Maybe we could help each other with tips and ideas for home vision therapy efforts that have worked (or not). Thank you, and may the force be with you.

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34 responses to “Vision therapy for toddlers… an exercise in patience.

  1. Pingback: Our vision therapy experience so far… on littlefoureyes.com « The Life and Times of Stella·

  2. Hi Amber, I LOVED reading about your experience and that you are also pursuing as wvision therapy for Stella at such a young age. We went through very similar experiences with our daughter, Ellie, who is now 4. I don’t have the time to go into details now, but I promise I will very soon! I also felt very alone as I did not find anyone else going through this at such a young age. We did vision therapy for approximately 4 months, also once a week and did exercises at home as well. We are still doing some of the exercises at home now as we have continued patching (we were told she will likely have to patch some until she is 10 as until that age her eyes will continue to develop and vision will decline again if we stopped patching before then). I have slacked off of doing the home exercises for a while, but we are going back into it full force very soon.:-) We absolutely LOVE our vision therapist, and believe she is the reason why we successfully avoided another surgery on Ellie’s eyes (she had her first one at 9 months before we knew anything about vision therapy). The reason we stopped seeing our vision therapist was because Ellie’s eyes had finally reached equal vision in both eyes, and her eyes were able to maintain straight for the most part. We were at a point that Ellie needed to do more involved exercises to help her learn to use the eyes together, and she was not cooperative or patient enough to be able to do them. One thing about doing vision therapy at such a young age is that their eyes and brains are still developing and growing, which may mean that you will have to do it for a while and then do it some more later as their brains and eyes change. I believe this is why most of the success stories are for children ages 5 to 10 as their eyes are not developing so rapidly anymore and results are typically permanent. I felt exactly like you in that I was not willing to compromise Ellie’s vision right now, and I felt that the younger she is the easier and better it would be for her to attain the best possible vision. All of the exercises you are doing are exercises we did with Ellie. I will have to expound on that another time as my four little “monkeys” are ready for me to get off the computer. If you want to email me directly, my email address is caekoenig at gmail dot com. All the best to you! You are awesome to be so involved and proactive with Stella! She may not like it very much right now, but I know she will thank you one day!

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  3. Hi there! Glad you enjoyed the post and I’m glad to hear we are not alone in our approach! I can relate to everything you’ve said–that it’s great to strengthen her vision as much as possible now (early on) so as to prevent bigger issues, but that more therapy may be needed later. We just talked to our vision therapist about this and I feel pretty good about it. I can’t wait to hear more about Ellie’s vision and story. Bravo for all your efforts–they no doubt helped immensely! I will shoot you an email. Thanks for your comment!

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  4. Very interesting post, Amber! I asked my child’s ophthalmologist about vision therapy exercises and he was dead set against it. He said that his experience showed that children who did a lot of vision exercises ended up developing vision problems (like double vision) as adults. A friend who is an optometrist said that there is conflict in the vision commmunity about vision therapy exercises. Surgeons tend to be against it and non-surgeons for it. Just like everything we have experienced so far in our our child’s strabismus treatment, there are conflicting opinions on just about everything. You really have to go with your gut and hope you are making the right choice. I sincerely hope the vision therapy works for your little one and hope you post again about your experience!

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    • Anne-Thank you for talking about how there are conflicting opinions on just about everything when it comes to treating strabismus!! I also experience this…alot…and it is VERY frustrating.

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    • Hello Anne…Your ophthalmologist is not keeping up with the current research and is using his “opinion” and not scientific fact to guide you. I have recently conducted a search on PubMed (a site that helps you find all the current research on any medical topic) and there is NOTHING that indicates that those who have optometric vision therapy and then surgery tend to see double as adults. As far as the conflict between optometrists and ophthalmologist…well ophthalmologists (and organized medicine in general) do not play well with those who do not have the magic MD degree. Medicine “fights” with nurses, podiatrists, psychologists and many other well educated professions as well. It is unfortunate that professional jealousy gets in the way of good patient care. For more information on the latest in children’s vision go to http://www.MainosMemos.blogspot.com. If you have any questions, let me know by emailing dmaino@ico.edu.

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  5. Anne, thanks for your comment!

    I’ve done pretty in-depth research on the topic of vision therapy. I can’t find a single study to report the anecdotal reasoning your doctor provided. I can find plenty that say the reverse… and I was kind of shocked actually, because “anecdotal claims” is usually the charge made by ophthalmologists against developmental optometrists/vision therapists. Also the claim is that vision therapy doesn’t produce the results promised (though certified VT’s never make outrageous claims that can’t be backed up), but I’ve never heard it said that it does harm. It was somewhat alarming to read that claim. Can your doctor provide evidence-based data to back up that assertion? Otherwise, I’d be very weary. Here is some solid support for vision therapy’s effectiveness in children, a summary of research reported in the Archives of *Ophthalmology*, funded by the National Eye Institute (NEI), part of the National Institutes of Health.
    http://www.nei.nih.gov/news/pressreleases/101308.asp

    I just read a paper exploring the adversarial relationship between the two schools of thought and it reaffirmed my belief that vision therapy isn’t very well understood by some ophthalmologists. Though, some ophthalmologists and VT’s do work well together. Wouldn’t that be a dream? I don’t understand why there is such a gaping chasm. If your hand is injured, you go to a surgeon to fix any structural issue, then to a physical therapist. You don’t go to the surgeon to rehabilitate your hand, and that’s obvious. Why can’t it be this way with vision?

    That said, every case is different, of course. There could be a reason why vision therapy is beneficial for one, but not worthwhile for another. It became clear to me through my research that Stella was a very good candidate for vision therapy and I was lucky to find someone who was confident in working with someone so young.

    The conflicting opinions are very frustrating and can be very disheartening and confusing. As I explained in my post, an ophthalmologist (whom did a great job with Stella’s glasses prescription and whom we still see for check-ups in addition to the work with the developmental optometrist) told us to simply patch, likely for years. One developmental optometrist said Stella was too young to do vision therapy (because she couldn’t focus on the exercises). And another developmental optometrist said Stella could do vision therapy and that she’d benefit from it. The only thing they all agreed upon was that she needed glasses, which was obvious! I’m glad I got three opinions, even though it was confusing. At the end of the day I used not only my gut, but my own research and hard question-asking to figure out what seemed right.

    I wish you and your child the very best in your dedicated quest to give her the best vision possible! It’s daunting sometimes, isn’t it? Sigh. Just feel good knowing that you are doing your best to help her. That’s all we can do, right?

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  6. I have to agree with everyone else that it is very frustrating when ophthalmologists do not agree with optometrists and vice versa. As a parent, we want to do what is the very best thing for our child, in this case, their vision, and yet, we cannot even make a decision based on a doctor’s recommendation because it conflicts from one doctor to another. We started seeing a Pediatric Ophthalmologist (PO) when Ellie was only two months old because her eyes were crossed and although this is normal for babies, it is supposed to go away at or around 2 months old, but it did not do so for Ellie. From that point on, we were at the PO every two months. Every time I think back at that time, I get frustrated that I simply trusted the PO’s opinion and advice and did not do much research on my own. When Ellie turned two and after having had eye muscle surgery at 9 months old, patching since she was four months old, and wearing glasses since her surgery, I had become so frustrated with our eye doctor appointments as it seemed like a complete waste of time. When I asked our PO what prospect Ellie had of ever achieving binocular vision, having equal vision in both eyes, and having her eyes remain straight, she told me that Ellie would never achieve binocular vision, that she would have to patch until she was ten, and that her eyes may never be straight. She also told me that Ellie had passed a “critical” period of vision development and that from this point on regaining vision she had lost already would be very unlikely. I was very frustrated as this was never discussed at any previous appointments. No one ever said that we need to work as hard as possible to get her eyes to see the best they can see before she turned two. The only suggestion that her PO had had after every visit is to continue the patching and the glasses and come back in two months. A friend had come across a vision therapist, and I was desperate to get some other diagnosis than that nothing can be done to improve Ellie’s vision. We went to see her, and finally I got back some hope that we did not lose all opportunities to help improve Ellie’s eyes. When our PO found out that we were pursuing vision therapy, she personally called me (she never called me personally before even when I was desperate to talk to her about Ellie’s eye drops she had prescribed and the reaction Ellie was having to it) to tell me that I was wasting my money and that she was highly against us pursuing this path. I told her that I was tired of coming to see her every two months without any change, without a new therapy, without a new path to try and with each visit she was two months older and had lost that much more time to regain what she lost. In my opinion the earlier a child learns how to use his/her eyes together the better the outcome. I watched a video today to support that opinion. You can read the article and watch this informative video on how vision develops here: http://covdblog.wordpress.com/2010/09/07/early-intervention-critically-important-in-childrens-vision-problems/ We started vision therapy and also changed ophthalmologists. Why did I wait so long to do that??? Hindsight is always 20/20. 🙂 We started seeing our vision therapist regularly and also did the recommended exercises at home, and Ellie’s vision started improving. Our new PO told us that his main concern was to improve Ellie’s vision. He said that he can always straighten the eyes with eye muscle surgery, but that this is purely cosmetic and would not improve the way Ellie sees. Therefore, there is no rush to get it done, but instead his focus was to improve her vision. THANK YOU!!! We started out at 20/100 vision in her left eye and after two months, Ellie’s eyes had finally reached equal vision 20/40 in both eyes! Yippee! Our PO was amazed what vision therapy and full time patching did to help Ellie keep her eyes straight. On our first visit, he was absolutely sure that she would need a second surgery, but once we got her vision equal, he realized that a second surgery may not be necessary. He changed her prescription, and she got bifocals and for the first time in her life we did not have to return to the eye doctor for six months!!! At that point, Ellie was not quite old enough to do some of the exercises required to achieve binocular vision, and we put vision therapy on hold for a little while until she was ready. I’m ready to jump back in it full force now and am very much looking forward to what this path will hold for her. We are still patching and will likely do so to maintain her vision until her eyes are fully developed at age 10. But I am hoping it will decrease more and more as her eyes learn to work together. Vision therapy is not an instant miracle cure. It is also not a cure for every eye condition out there. It is not an easy fix as some other medical treatments are. It requires a lot of work,patience, time, commitment, and yes, money. Why do insurance companies not pay for vision therapy when it could potentially prevent a $20,000.00 surgery? (yes, that’s how much eye muscle surgery costs, I have the bill!) They claim that there is not enough evidence to support its effectiveness, but maybe it is mostly because not enough people have been made aware that this is even out there. I am planning on submitting a full report to our insurance company and detailing how much money they could save if they would make it a covered benefit. For a long time, chiropractic care was an uncovered benefit on many insurance policies yet today it is commonly covered. Why? Because insurance companies realized its effectiveness and how much money they could save. I believe that we can also help them realize that about vision therapy, but it will take time and many parents who will advocate for vision therapy. I’m sorry this turn out to be so long. I wish I would have more time to do more frequent updates in posts. Maybe one day… 🙂 I wish everyone all the best as you do your research and determine what is best for your child’s vision and as you navigate the line between conflicting doctor’s opinions.

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  7. Pingback: New glasses, a new outlook, and a wide open space. | The Life and Times of Stella·

  8. Couldn’t agree with you more in so far as differing opinions. When I have brought up VT with two prominant opthalmologists they slammed it saying that it was a complete waste of time and money and would not help Paris at all, which I will admit did put me off. Now that she is nearing four I am keen to give it a go. I dont care what it costs if it helps! I also CANNOT believe insurance companies, mine included, do not cover it, unbelievalbe! I think it is becasue they dont know enough about it. Yet they cover podiatry and physio and homeopathy! but not something as essential as vision therapy! I am also going to submit a report to our insurance company detailing the benefits. It certainly is a journey that we face with children with vision issues that’s for sure. You are absolutely right to ditch the first PO and glad you have found someone more progressive and forward thinking and what fantastic results.

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  9. My eye doctor wants $75 per 1/2 hour session x 16 sessions plus $600 for two computer courses – $1800 ie plus additional $75 session if needed. Does this sound fair? $150 / hour of the specialists time? What is the cost to them for this software that they sell to us for $600? Seems absurdly priced to mee. Can anyone recomend a VT that s good and charges a reasonable rate? I’m an expert in my field and make $50 an hour maximum if everything goes according to plan… but on avg I make more like $30/hour… I have more education and training than a VT. I hate how people and businesses overcharge honest hardworking individuals. I am located in Vancouver Canada.

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  10. Hi there! (I wrote this post about my daughter’s vision therapy.) I’m not sure how it works in Canada, but those prices are in line with what we see here. Except, for some, it’s covered by insurance. All life-changing therapy is “expensive” but most types of therapy (from physical therapy to occupational etc.) are covered by insurance. if not, I’m guessing you’d be paying way more than what you are for vision therapy. (We did occupational therapy when Stella was a baby so I have some experience upon which to base this.)

    Please don’t confuse what you’re paying with what a vision therapist makes. I can assure you, their salaries are much more modest. That rate you’re quoting? It includes overhead for running the practice (administration, rent or mortgage for the building, etc.), the time of the optometrist who consults regularly with your therapist about your progress in order to expertly guide treatment, and highly specialized equipment for use in the office and for signing out and taking home. The yoked prism goggles my daughter uses cost $1000–a cost incurred by the office, not us. They have literally opened up her world.

    What’s expensive is not doing vision therapy when you need it. Not being able to read without agony, not being able to drive safely or participate in sports, having to go through life with searing headaches and a disoriented brain, not being able to pay attention, or being unable to live up to your potential and failing again an again in various arenas in life despite your best efforts. Those are real costs, and they are immeasurable. When you look at it like that, it’s actually a bargain. We pay $125 per week, for 45 minute sessions, and it’s not covered by insurance. Though I know other insurance companies (other than ours, which is pretty poor) do help cover it here in the U.S. The sacrifice has been worth it for us, and our optometrist’s office has walls and binders full of success stories. I suppose that’s why she has a long waiting list.

    All that aside, you are asking good questions and should get more information before you move forward. It is an investment and one you should feel great about. Can you go to another optometrist offering vision therapy and get their opinion and compare therapy strategies, goals for your program of therapy, and pricing?

    There are a couple of great resources that may be helpful:

    Sovoto, a vision therapy community where vision therapists, optometrists, and parents and patients all come together to ask and answer questions:
    http://www.sovoto.com/

    The Vision Help Blog, by prominent US optometrists. The main author, Len Press, is great about replying to comments. I’d recommend finding a relevant post, and asking any questions you have about costs and approach. Also, it’s just a fascinating read, covering the latest findings in vision therapy, and many case studies and success stories are shared.
    http://visionhelp.wordpress.com/

    Best of luck!

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  11. Found a vision therapist in the same town who does it for twenty five dollars for a forty five minute session out of a clinic. Her take is that a half hour is not enough time. Overhead is not that expensive. As you say “What’s expensive is not doing vision therapy when you need it. Not being able to read without agony, not being able to drive safely or participate in sports, having to go through life with searing headaches and a disoriented brain, not being able to pay attention, or being unable to live up to your potential and failing again an again in various arenas in life despite your best efforts. Those are real costs, and they are immeasurable.?
    While this is true and I believe you.. clinics use this gouge the customer. They prey on the vulneraility of their patients and use their implied trust to overcharge their customers. I think this is unethical behavior and now that I have found someone else in the industry to do it for one sixth of the price….. I am certain of my previous convictions.

    Another thing that made me wary of the clinic was the fact that they wanted you to sign a contract in advance stipulating that missed appointments were chargable regardless of attendance or reason for missing. No rescheduling was allowed even with given notice. Thus… given that life is uncertain.. it is expected that you will miss one or two sessions over a 32 week period… thus the average effective hourly rate you pay becomes in effect larger than 150 per hour.

    Think of a mechanic… their shop rate is 75 to 95 per hour and they have a higher rent and annual profesional dues and more invested in fixed assests than does an eye clinic. Charging 150 per hour is just highway robbery.

    thanks for allowing me to share my views.

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  12. Hello John and Marc,

    Stella’s mom invited me to reply to your concerns about fees firsthand. Clearly when you pay for vision therapy services through a doctor’s office you’re not purchasing a product. It isn’t the commodity you’re paying for. You’re paying for the doctor’s time and expertise in arriving at a diagnosis of a visual problem, then arranging a therapy program so that your child can benefit from the effort involved all around. If you want an example of unconscionable billing, don’t look toward vision therapy. Look toward Corrie’s post on November 24 above. A $20,000 bill for eye muscle surgery? Are you kidding me? How much do the blades and sutures cost? How much is the doctor being paid on an hourly basis?

    Marc, I agree with you that any practice should have a reasonable policy for missing appointments. In our practice, for example, we will always reschedule an appointment. We ask the patient, as a courtesy, to give our office 24 hours notice when they cancel. There is only a fee for missed appointments when a patient cancels three times without any advanced notice. We’re doing this to collect extra fees; we’re doing this because we know that consistency and continuity of care is the key to a successful outcome. We put everything in writing at the outset so that the parents knows exactly what their responsibilities are.

    Let’s face it. In any service industry you can find a provider willing to do something cheaper. That was the basis of how insurance programs started in the first place. Some entrepreneurial doctors got together to undercut the going rate by arranging to see more patients and using volume to offset their lower rates. Invariably, however, you get what you pay for. To do vision therapy well requires a significant investment in time and resources. In our practice we have four full time and two part time therapists. We pay them very equitable salaries, and invest in education and chart review time. We brainstorm from week to week on patients’ progress, and use progress evaluations to fine tune the direction in which we’re going. Although we are not participating doctors working for insurance companies, we serve as strong advocates for patients to be reimbursed to the extent that there policy provides. We get on the phone or via email and through reports communicate with educators or other professionals in the child’s life. There is a tremendous amount of work that goes on the scenes to enable your child to have a successful experience in a competent vision therapy practice.

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  13. My daughter started vision therapy at age 3 and 11 months. That was 5 months ago. She is sensitive and stubborn and we share a lot of the challenges you mention. I see it was a couple of years ago when you posted so I’ll have to check out your blog.

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  14. My daughter was diagnosised with accommodative esotrophia due to farsightedness yesterday. We noticed 5 days ago occasional crossing of eyes intermintently. By what I would say a miracle, we were able to get into a pediatric opthomalogist yesterday morning where she was checked. I have been overwhelmed with emotions and information. My husband and I returned home where my opthomalogist examined her again and agreed that she has +7 in the left and + 5 in the right. At this point I want to do what is best for my daughter but not really sure what to do. We have ordered her first set of glasses, but I am nervous if my 2 1/2 year old will be cooperative. I am very new to this and want to take every measure to help my daughter any information would be appreciated. I am very interested in vision therapy in my area. I live in Kentucky and am willing to what ever I need to to help my daughter get the best care possible. Any suggestions would be appreciated. I would also like advice regarding her treatment.

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    • Hi Janet, it sounds like you want as much information as possible on all of the available options for helping your daughter. I think that means getting multiple opinions. You have the opinion of an ophthalmologist so perhaps you could also get the opinion of a developmental optometrist who offers vision therapy. You can go to http://covd.org, click on “Locate a Doctor” and find someone near you. Best of luck!

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  15. I am glad to come across, this page, I have been doing a lot of research on vision therapy as well. Crossed eyes runs in my family, both father and brother had surgery. My son is 9mnths, and I took him in at 5months to the pediatric eye institute. I caught his strabismus early since I saw my brother wear glasses,, patch, and have surgery at age 6months, and 12/ months. My brother is now 15 and one of his eyes now wonders out instead of turning in This is something I have heard from both my son’s vision therapist, and read in articles online.. My son was suppose to have surgery on Dec. 5 2012,. and I could not come to peace with the decision to go through with it. I had been praying for peace and wisdom on how to handle this situation, and the day I was filling his paperwork , I came across vision therapy, and canceled his surgery that day. From what I understand, yes, surgery can cosmetically alight the eyes, but it does not mean it will stay that way. Babies eyes are rapidly changing and growing, and it did not make since to me to have it that young because there was no promise of success, and his PO said his vision might improve, and he could grow out of glasses. B.S,.Well I looked into it myself, his” muscles”” COSmetic surgery ” wont correct his vision, it is determined by his brain, as well as his crossing. if he had his surgery the doctor said without glasses he’d go back to being crossed.That was a big reason why I didn’t feel right with the surgery. My son is also farsighted, and started wearing glasses at 6months.
    Well I searched for a vision therapist in my insurance, and every optometrist in our system only specialized in EYE MUSCLE SURGERY. I was concerned with the cost of Vision Therapy, being that my son is so young, and wandering if it was worth trying something like this, or putting him through surgery which I felt we could handle because it would be less traumatizing now, then later when he was completely aware of what was going on.As a mother or Father you want to make sure you are doing the right thing. I CALLED To find the cheapest therapy session, which was around 79 dallors, and I even looked into colleges, because I know they have interns and doctors ect.. Not to mention are right up to date with any new information that will be leading our future (like hybrid contacts) I came across western university of human science, and they said their vision therapist would take him for free until he turned One. I know my son is a lot younger then most people on this webpage, But I have high hopes because I am very determined to help him, and learn everything I can, like making my own cards at home for him and looking online for things to get his eyes to move. Our vision therapist suggested something called OMM (osteopathic medicine) she said she saw success with kids eyes straightening out. She described this procedure like it was a massage that loosens up his muscles to his eyes,because his muscles seemed to be tight. Amazing I thought, I found to trust these people way more then my PO, They gave such an in depth exam.
    They also told me they wouldn’t have proscribed my sons prescription to be so high, because they don’t want him to always rely on a super high prescription his whole life. That made since to me, I was upset when they told me this because no joke, the day after i GOT MY sON’S glasses, the next day when they were off, his eyes looked worst then ever. They told me NOT to patch, in his case, because he needs to learn to work them together, and put tape on the insides of his glasses. The told me they wanted to lower his prescription, and the first step for him being so young is the OMM. we have not gone yet, but I am up for anything. I believe in the natural ways of life, why not try it before making such a huge decision like surgery. Thank you for sharing your story and offering your information to other people. I have not been able to express myself to anyone in a situation like mine yet.

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      • thank you deedee. I am located in wildomar ca, but i go to Pomona CA for his vision therapy. I have not gone to any sessions yet because I am in the process of getting him an apt. for OMM. Have you heard of this? And yes it was such a blessing to get this appointment for free, and have contact one on one with his doctor who I can call at any time.

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    • Hi Britney (from the person who wrote this post)! It sure is clear that you want to do everything in your power to help your son and that you ask very good questions! It’s incredible that you were able to find someone to work with your son for free, until he turns one. Are you in California? I found this: http://wsprod.westernu.edu/news/nr_detail.jsp?id=9662&groupname=AllNews … is this where you are going for your son’s care? Looks pretty great, and COVD affiliation! Wow, I think you’re in really good hands!

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    • How did the OMM help your son so far? I am very interested to hear about it!! I am going to look into this for my daughter. thanks!!!! 🙂

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  16. I am so, so, so impressed with this article and even moreso with the comments! I am a vision therapist in Sammamish, WA, and love what I do. I have never been more passionate about a job, and seeing so many lives being changed.

    I will second Len Press’ comment about the cost of therapy. So much of our time is spent in planning specifically and individually for each and every patient. The Dr. writes individualized plans according to our patient’s needs and is consistently in contact with schools. On top of that, she carries a full patient load, prescribes glasses, does check-ups and deals with insurance, and always takes work home. And I am always impressed that she cares about her patients care, regardless if their relying on the state. She’s been known to provide practically free care to some. Why? Because Vision Therapy Helps Them. I don’t know a busier, yet more devoted person. I don’t think she gets paid well enough.

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  17. Hello! Thank you fr the amazing write up on your experience. My son who is 3 and a half has exactly the same situation as your daughter. My problem is he will not cooperate at all for at home therapy. Can you please help me with some eye excesses that are fun and my help him. I am not impressed with his occular therapist at this time as I feel she has not customized his exercises and does the same general exercises for everyone. She is also very rushy and is not patient enough. We live in Toronto and if anyone who reads this knows of a good vision therapist please let me know. I love the optimistrist there but not the vision therapist. She rubs me the wrong way and I am going through very mixed emotions and I’m sad for my son as there are other health issues we are dealing with as well. The pain in my heart is unexplainable. I need a solution and some eye exercises that don’t feel like he is doing therapy. I need to incorporate some fun. Thank you for reading my comments and would love to hear comments. Dig down deep for patience!

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  18. I happened to stumble upon this while doing research on eye surgery for my son, Iain. He is 3 years old and has been in glasses since he was 18 months to help fix his partial accomadative esotropia. In December of 2012 he was put into bifocals. Today we were told that he needs surgery to help with the depth perception. He has none. His pediatric opthamologist never even mentioned vision therapy as an option. I read another article that says vision therapy should be done prior to surgery because it increases the possibility of a successful surgery. It is supposed to help the eyes work together as vision is developed in the brain not in the eyes. It also stated that without vision therapy you may notice that the eyes are straight after surgery for a short time before they start to turn again because the brain doesn’t know how to use both eyes. Does anyone have any experience with vision therapy with the surgery? I plan on doing more research on vision therapy and to see if there is anyone in our area that offers it. Thanks

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  19. We recently started vision therapy with our almost 3 year old who has shorter attention span than most kids his age. We are having such a difficult time doing the exercises at home and like your experience it often turns into a very stressful situation. He hates…and I mean hates…using his learning eye and often just plain refuses because it’s difficult and uncomfortable for him. If you have any suggestions from your experience on how to make this less of a fight please email me or post and let me know. I am looking for ipad apps and creative ideas to make it more fun and less stressful. We tried chocolate chips too but they are no longer successful either. I appreciate your blog. Thank you for sharing!

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  20. Hi, may I just ask how is her eyes doing at present? My 2yr old son currently have the same vision problem and I’m at a loss on what to do. He refuse to have the patch put on his eye..

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  21. Pingback: Seven Years! (7 best posts and 7 book giveaway to celebrate) | Little Four Eyes·

  22. Hi amber. Can you please help me. My baby is 6 months was under gone with retina detached operation in his left eye. After his operation ophthalmologist adviced us to give patch exercise to his eye. But his refused to do it. Often started crying. How can i do this to him to improve his vision in his left eye. I am so worried about this. Please help.

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