If your child did poorly on the Vision Assessment Checklist on the previous page, you need to locate a developmental optometrist to perform further testing to diagnose the specific vision problems that your child might have and to see if vision therapy will help.
First, Locate a Developmental Optometrist
Ideally, you want to locate a developmental optometrist who oversees a vision therapy department that offers Office-Based Vision Therapy somewhere near you. Alternatively, you might find a developmental optometrist who routinely refers to a vision therapy department. This is essential. An optometrist who doesn’t refer to vision therapy is unlikely to perform the testing necessary to determine whether your child suffers from the sort of vision problems corrected with vision therapy.
The easiest way to get started is to go to the website maintained by the developmental optometry professionals at www.covd.org. Once you get there, use their “Locate a Doctor” search box to find a COVD-certified optometrist in your area. Hopefully, you will find one, though it’s not unusual for parents to haul children sixty to eighty miles to reach the office in my area. If you live outside the U.S., use the Advanced Search feature to get a country listing.
Questions to Ask When You Call the Optometrist
1. Do you offer office-based vision therapy? If not, do you routinely refer to a vision therapy department, and which one?
Reason for asking: You want to locate office-based vision therapy, if possible. An optometrist who only rarely refers to a vision therapy department is not as likely to perform the necessary testing to determine the need for vision therapy.
2. Is there an opportunity for the parent to oversee daily exercises at home between weekly or bi-weekly visits to the vision therapist?
Reason for asking: While you want to locate office-based vision therapy, the most reasonable way to do it is to take your child in about once a week for therapy and to then get instructions and materials for continuing the therapy exercises at home on a daily basis. Doing it all in the office will come close to tripling the cost in some cases.
3. How much will it cost?
Reason for asking: Obviously you need to get a feel for the costs, especially if you have more than one vision therapy department in your area. You can expect to pay several hundred dollars for the initial testing if it includes a developmental vision evaluation. If your child needs vision therapy, each visit is likely to cost around a hundred dollars (or more in many practices) and the number of visits could be as few as 12 to as many as 36 or even more depending on the extent of the vision problems. Total charges are likely to run between $2,500 and $5,000 depending on several factors including typical charges in your area, the number of sessions, whether you can do exercises at home, etc.
4. Do you need to repeat an eye examination if your child has recently been to his family optometrist?
Reason for asking: A developmental optometrist will run a different set of tests than your family optometrist. However, before doing so, he will want to ensure the overall health of your child’s vision system and might do a dilated eye examination (where the pupils are dilated with drops so he can examine the inner structure of the eye.) If your child has recently had one done, most developmental optometrists will probably accept your family optometrist’s report, saving you the cost of repeating that particular exam. Also, if insurance covered the earlier exam, your insurance company is unlikely to pay for repeating the test too quickly so failing to ask this question could cost you money unnecessarily.
5. Does insurance cover vision therapy?
Reason for asking: Obviously you want insurance to cover it, but insurance usually doesn't vision therapy sessions, although that seems to be slowly changing. Usually it’s your medical coverage that will apply, not your vision coverage. Be especially careful to ask about both the examination costs and the vision therapy costs as separate items. Often your vision insurance will cover the initial examinations, but will not cover the vision therapy sessions themselves. Hopeful parents, hearing that insurance will cover the exams, then sometimes assume that it covers everything only to get halfway through vision therapy and then find that the sessions have not been covered. Be diligent in checking this out.
6. Do you have references that I can contact?
Reason for asking: By references, I mean satisfied parents, not other eye-care professionals. A good vision therapy department should have dozens, even hundreds, of parents willing to vouch for their services. It takes a lot of effort to learn about, and obtain, vision therapy and parents often want to save other parents the stress they went through agonizing over whether to pursue vision therapy. On the other hand, many children have not gotten the vision therapy they need because a parent will follow up the vision therapy call with a call to their family optometrist, or their pediatric ophthalmologist, or just to a friend who’s an eye-care professional. Unfortunately, they will often get the response that vision therapy is “not proven,” “unnecessary,” “a waste of money,” “time wasted when other actions should be taken,” etc. You need to be aware of this. To better understand what’s going on, take a look at Does Vision Therapy Work?
Should I get the testing if vision therapy isn’t possible now?
Yes, even if you have to travel hours to reach the developmental optometrist. The reason is that then you will learn whether or not a vision problem is making school difficult for your child. The knowledge that your child has a diagnosed, although still untreated, vision problem will enable you to more effectively communicate with school officials and teachers as to his needs. In some states, it might even be enough to get the school to provide direct help in the vision area, although to my knowledge no school currently provides vision therapy as a school service (as they do speech therapy, for instance.)
Also, knowing about the vision problem will change your perspective on your child’s behavior. You will understand that his reluctance to read isn’t laziness, but actual physical discomfort. You will also be more likely to figure out what's going on if his visual skills eventually improve to the point where he is finally able to improve his reading skills.
Alternatives to Vision Therapy
Vision therapy is exactly that, therapy. As with any therapy, such as physical therapy or occupational therapy, it’s billed at professional rates for professional time. The main reason it’s viewed as excessively expensive by many parents is because insurance often fails to cover it.
In my opinion, the best route to take is office-based vision therapy approximately once a week while doing home exercises religiously at least four or five days a week between sessions. However, there are developmental optometrists that will offer computerized vision therapy for certain vision problems that can cut the expense. I can’t vouch for these programs, as I have no experience with them and the practice I’m familiar with didn't offer them at the time. That doesn’t mean they don’t do some good, however.
Some optometrists will prescribe simple pencil push-ups to address a convergence problem. This might even work for a certain percentage of children, but you’re much more likely to get to the root of all of the vision problems if you go the office-based vision therapy route. This is also borne out in the Convergence Insufficiency Study I discuss elsewhere.
The Consequences of Waiting
For various reasons, parents who want to pursue the vision therapy route are often unable to do so. You might not have the money; there might be no developmental optometrist near you; you might not have the time to do the home exercises; your spouse might have custody in a divorce and be unwilling to cooperate, etc. So, what happens then?
In time, a child’s vision skills might develop to the point where reading is no longer a chore. This can happen at any time and explains why some teachers “all of a sudden” find that Johnny is “getting it.” Alternatively, his vision might adapt so that he is doing all of his reading using only one eye, thereby clearing up the confusion caused when he was using both eyes. This is unlikely to happen until he is older, well into his teenage years or even adulthood, if it happens at all.
Until his vision skills either mature or adapt, your main challenge will be to keep the school educating your child by providing him opportunities to learn by listening, watching and participating. Too much time is wasted when children with vision problems leave the regular classroom and go to a resource room or special ed class where they are then asked to do what they are essentially either unable or unwilling to do, i.e., learn to read. While a good phonics background is essential for these children to learn to read, they will rarely read either fluently or willingly as long as their vision problems are unresolved.
Consider also that our jails are over-populated with people with vision problems that have never been diagnosed, much less treated. To minimize the chance of this dire consequence, it is important to realize that your child’s vision problems should, at a minimum, be diagnosed so that parents and school personnel can truly understand his situation and can continue educating him in spite of his inability or unwillingness to learn by the route of independent reading.
The next page Convergence Insufficiency, explains a common vision problem that can affect reading ability and is best addressed by vision therapy.