Gifted Issues Discussion homepage Forums Twice Exceptional Vision therapy for dyslexia

My dd11 is formally dx with inattentive type ADD but dyslexia really fits in many ways as well. She went to bed crying last night about how stupid she is. What prompted this was the fact that, like usual, she had a few questions on her Algebra homework where she didn't understand what they were asking b/c she just doesn't "word" things in her mind the way the typical person does. She really understands the concepts well, but not the way things are being asked.

None the less, she is doing quite well in school and tested as "advanced" on all of the state tests last year in 6th grade and very highly on the math MAPS. I still feel that something more needs to be done to help her.

She has issues with strongly disliking reading for pleasure despite reading comprehension being above grade level, losing her place on the page, fatigue while reading, headaches, and substitution of words. She is also HG (possibly +).

What she does not have is the traditional phonics issues or writing issues. Her phonemic awareness is very good and always has been. Her writing is not messy and does not run above or below the lines. She, technically, spells well in that any spelling tests such as the spelling subtest on the WIAT are in the 80s (percentiles), but she isn't really a great speller. It isn't causing her major angst, though. Spelling tests significantly below her other reading skills on these types of tests, though. The other thing that has tested well below other reading skills in the past is speed. She reads very slowly.

So, I am reading some stuff claiming that vision therapy would help with these issues. I am also reading stuff like this statement from Children's Eye Foundation that essentially say that we'd be wasting our money. Vision therapy is not covered by insurance and is very expensive and we can't afford to waste money if it won't help.

The worry I have is that, while we have a nationally well known behavioral optometrist in town as well as a number of other behavioral optometrists, I don't know anyone who has gone for an evaluation with any of these individuals and been told that there is not a problem that can be treated with vision therapy. I fear that we're going to be told that she needs vision therapy regardless of whether it will fix the issues she is having or not. Any thoughts?

Hmm. Yes, the behavioral optometrists would definitely be biased in favor of promoting their livelihood. What does your family doctor say? Also, do you have any way of finding & speaking directly with others who have actually had vision therapy to see what they think?

It may come down to a leap of faith on your part, like a friend of mine took with her daughter and cognitive training. Of course all the trainers themselves advocate the service and it's not covered by medical. She finally took the chance and spent (literally) thousands of dollars to put her daughter through it - classroom sessions, a trainer, homework... and it worked. It really, really worked. Her daughter is a different kid now: focused, organized, can self-manage, excels in school, etc etc.

Anyway, best of luck. I hope you find the answers you seek and if not and you take a leap of faith that you get the results my friend did with the CT

I honestly haven't asked. Are you asking what the ped thinks about vision therapy as a whole or whether she thinks that it would be beneficial for dd? We don't go to the dr very often and haven't discussed any of these issues with her, so I don't expect that the ped thinks that dd has any issues right now. She presents as quite "normal" on the surface and does well in school so the times we are at the dr and answering their typical developmental questions have never raised any concerns for the dr.

Maybe. I can always ask the OD's office, but I suspect that they'd only give me the #s of happy people. I can also ask around at work b/c I work at the local hospital or post something to a parenting listserv that I belong to. The listserv tends to draw more "crunchy" types and parents of younger children, though.

Both. I approached our GP to ask about chiropractic therapy for DS8's ADHD (it was an interesting idea to me because there are spine issues in our family), and my doc basically said "well if you have extra money to throw away trying that I suppose you could." I've never pursued it, and it's not because of her disdain for the idea (I tend to do what I want regardless of what people think). What occurred to me later was that I myself had doubts (safety?) and was really just bringing the idea to the doctor as a "should we rule this out?" question (does that make sense?). Anyway, you could ask your ped both questions: what does she think of VT in general and what impact she thinks it will have on your DD. More opinions are always good, and it might resonate something within you as to whether or not you should proceed (as in "show you how you really feel").


It would be good to do both, I think, if you've got the time. One of these people will say/write something that will ring true for you in either direction. The bottom line is no one can make a better decision for your DD than you - you just need a way of accessing your decision. I would definitely talk to people who have been involved though.

Hmmm. My son receives vision therapy so I am getting a lot of experience in this area these days! I'll give you some of my thoughts and experiences so far. Hope they help you.

First, my insurance (Aetna) covered all of my sons vision evals and tests with the behavioral optometrist (and he had hours of it) and covers the vision therapy; although, I have a somewhat high specialist co-pay. So, don't automatically assume it is not covered. I automatically assumed that last year and wasn't as persisitant as a result and lost of year because I kept hearing "insurance doesn't cover that."

Secondly, just as an overall comment on it, so far - I have definitely seen a big improvement in my son as has my son's OT. His OT (completely different place than his VT and not related in any at all) has been doing periodic assessments on his tracking and visual perception, etc. - there are significant improvements documented. It brought tears to my eyes last week when his OT showed me how far he has come. I should add though that he gets visual stuff incorporated into his OT as well. Also, most heart warming my son has noticed a difference. One basic physical improvement I have noticed is less complaining of eyes hurting and his eye rubbing while reading has dropped significantly.

Thirdly, I have known people to go to a practice near me (they are complete eye doctors - treat all ages, sell glasses, do the behavioral optometry things, too) and be told there is no big issue (no diagnosis or whatever) but they get told vision therapy can always help this that or the other thing and that it would be beneficial), etc., etc... My son, on the other hand, was actually diagnosed and the options are VT or surgery or both. Like, there is difference between - "yeah this could help anyone. Your child can certainly benefit" and "your child's eyes are crossing (or one is wandering or whatever) and VT is option and/or surgery" YKIM? I think you could tease that out with a good, above-board doc.

Fourth, I was able to observe the evals and tests. I could see my son's vision fall apart. It was really obvious in certain tests. So, I have so far never felt like I was being 'tricked' or being sold on something he didn't need.

Another thought I have is to take her to an OT *AND* one of the respected behavioral optometrist for two sperate opinons. With my son, not only could I see a problem with his vision, his OT could as well (actually two of them - different ones from different practices who did not know each other). My understanding is that there are evals OTs can give that can indicate problems with visual motor integration, tracking, visual perception, etc.

Just as a warning re pediatricians, I have heard that pediatricians completely discount Vision therapy. With my own pediatricain, my son did have problems with the exam - he had 20/20 but he complained his eyes hurt during the exam, he became temper-tantrumy, his eyes began to water, etc... the Ped simply put it down to behavior. I didn't discuss/question it or anything but I did file the experience away in my head as odd and added to it as I noticed various problems my son seemed to be having with vision. I have no idea what my pediatrician would have said but honestly I just don't ask their opinion about this sort-of stuff. My ped knows very little about hypotonia (he admits that himself). I have heard peds say the most grossly erroneous stuff about breastfeeding, etc... I just don't trust them for most issues other than like illness issues (like kid has a major sickness). YKIM? Another woman I was talking with in the VT office whose som has same diagnosis as mine said her pediatrician just pushed surgery to fix her son's eyes but she wanted surgery to be a last resort particularly b/c surgery really doesn't have a high success rate despite the fact that surgery doesn't have a high success rate he pushed that and discounted VT. So just my experience and some food for thought.

All in all I don't know yet if my son has dyslexia and the VT doctros told me VT will not "fix"/treat dyslexia. It will treat his crossing eyes though. So dylexia/dysgraphia is still currently on the table to be looked at for my son. However, I soooo wish I would have considered and tried vision therapy earlier. I truly, truly do... It is one of the biggest regrets so far I have with my son - seriously.

Hope all this helps you somewhat!

Oh and my son doesn't have the phonics issue either, which is why I suspect dyslexia but that it never quite sits right with me with my son. He sounds words out just great - as long as his eyes get the sequence right. I can see that when he reads - example: sometimes when he reads and a word ends in LS, he'll start sounding the word out with an "sl" sound meanwhile the word actually begins with say a "B" When I stop him and I say "what sound does B make?" he says, "Uh bbb of course mom" and I'll say "then why are starting that word with the sound of "sl"" and he'll seem confused and be like "Ohhhh I don't know." Then he'll sound it outright. It's like his eyes keep tricking him, yk? He constantly sees lower case "a" as "e" but he knows e sounds like "ehhh" and a sounds like "ahhh" no problem.

Basically, what I see is he can sound out words phonetically really, really well - he is a good decoder (he also spells well as a result). BUT one of his big problems is he is often not "seeing" the letter in the right order/sequence (or seeing the letter right or word if they look too much like each other).

And that is where I have noticed so much improvement since he started VT. He is now getting the sequence right more often!

These are my son's exact symptoms. Exactly. This sounds just like him. But he does have the writing issues; however, he does have hypotonia, which has been what his writing issues have been attributed to.

When my son did his tests, I could actually see his eyes crossing and him pulling them back. His left eye wantdered more than his right.

Also, my son loves to be "read to" - he loves "reading" and always has as long as he isn't physically doing the reading. It's so sad because he couldn't wait to be able to read himself, he loves books so much but it is soooo physically hard for him and just never seemed (prior to VT) to get easier, he never seemed to get more fluent... He began to run and hide and do all kinds of opppositional behavior to get out of readong. and now we know why.

Oh one more thing! (sorry) I read on the Children's Eye Foundation site that you linked this statement:

"Orthoptic eye exercises as prescribed by pediatric ophthalmologists, orthoptists, and optometrists can be beneficial in the treatment of symptomatic convergence insufficiency"

And that is my son's diagnosis symptomatic convergence insufficiency - specifically intermittent symptomatic convergence insufficiency. So actually it looks even the Children's Eye Foundation does endorse it for that diagnosis, which would be why it's been such a good experience for us so far.

I guess what you really need to find out is does your DD actually have dyslexia or does she have a symptomatic convergence insufficiency?

As an aside, once dyslesxia is diagnosed does insurance cover any of the costs in general of treating that? special tutors or whatever? Just wondering in case my son ends up witht hat diagnosis eventually.

My son has dyslexia, has an ADHD diagnosis, and is likely HG underneath it all (though he tests at slightly under HG).

He did vision therapy before he had a dyslexia diagnosis, and to her credit, the optometrist said after she evaluated him that she had "an answer, but not the answer."

I believe that VT helped him quite a bit, though it did not treat the underlying dyslexia. I think it particularly helped with allowing him to develop his strengths (M strengths, if you're read The Dyslexic Advantage). A bit of concrete evidence I have for this is that his block design score on the WISC IV went up by 6 points after VT (his IQ was tested about a year prior to starting VT and again about 4 months after finishing). Obviously the change could have been due to a number of factors (and probably was) but apparently depressed block design scores are a red flag for vision issues.

I work in healthcare and our insurance is through my employer. I am very familiar with our insurance and have already checked on all of these things. We have "basic vision" which will cover the cost of a regular eye exam, but not a developmental exam. They will not cover any treatment (OT, PT, vision therapy) for anything they view as a "chronic" condition not an acute condition. So, for example, my dd13 was dx with dyspraxia and SPD at 7. They won't cover a retest now that she is 13 b/c, even if they are no longer diagnosable and even though they are treatable, the types of things that the OT would be testing for are considered potentially chronic.

Convergence insufficiency and dyslexia are also considered chronic in their estimation even though they are/may be treatable so no testing or treatment for either is covered. For vision therapy, we'd be looking at $600-800/month. This could, obviously, add up quite quickly.

YUP - That was huge for me ... watching my son do the block design subtest on the WISC IV...

That's interesting. My dd has taken the WISC-IV twice, but not in a few years. Her block design scores (like all of the other scores) were erratic, but not technically "low." She got a 15 the first time and a 12 the second. Her two WISC GAIs were 99.9 and around the 98th, if I recall correctly. The second, much lower, GAI was due to the PRI index (which includes the block design) going down in the one year btwn the first testing and the second. Either way, she's gifted, but the varying scores were odd. Both times her VCI was in the 99th+(+), so HG+. I would expect a HG+ verbal kid to read more/better/like it more than she does, though.

I was told that, due to the controlled nature of the test, that there was no way a parent or anyone could watch the testing, so I have no idea what she looked like while testing, unfortunately, but I will definitely inquire as to whether I could watch a behavioral optometry exam.

This is interesting to me only because I have heard and read that before but the evaluators gave me no trouble about observing (My son was tested at AI Dupont so it's not like it was some rinky dink place or something)... A friend of mine in another state observed her son as well but it had to be such that her son could not see her. I feel so lucky I could observe... I really learned a lot about my child that I couls not have gotten from a psych report...

Oh bummer. So sorry to hear that... yes, $600-800 per month is so much money One thing I explored when I thought my insurance wouldn't cover the therapy was a teaching eye institute (http://www.teivision.com/services_pediatric.htm) where they do things a free or reduced costs... It would have been a hike into a very congested part of Philly (would have been a nightmare to do twice a week) but had i been somethign like that in your area you could look into that.

Just so sad that only the very wealthy can get help and therapies for their children... just doesn't seem right. My child would have suffered so much as he progressed in school as well as in other areas of his life if we couldn't afford the co-pays and get most of his therapy covered. Breaks my heart for those out there that can't get access b/c of money . This stuff is soooo expensive

For now, I changed the font on her Nook to Trebuchet, which is listed online as a good font for reading by dyslexics and we adjusted the line spacing so there is a lot of space btwn lines. She says that is easier to read.

If I can talk dh into it, I think that I am going to see if we can at least spring for a developmental eye exam with someone who is fairly local and who seems to be well known in the behavioral optometry field as I've seen a lot of national publications with his name on them. I don't know what we do if he says that there is a definitive problem and we can't afford to treat it, but I guess that we'll cross that bridge if we get there.

Cricket, my dd10 had VT when she was 8 and it made a *world* of difference in her life. She struggled with reading but did not have dyslexia - see my comments below:


This was true for both my dd who went through VT (before VT) and for my younger dd, who was found to have a weakness in associative memory. FWIW - it was recommended to us by her evaluator that if her reading didn't improve after other accommodations we should have her go through a VT eval also, which we will be doing later this fall.


There are other types of reading challenges that aren't necessarily dyslexia, including vision challenges. My dd10's phonemic awareness was actually among her highest scores on neuropsych testing. In her case, however, there were very very obvious dips in block design and symbol search on the WISC and another non-WISC test that relied on vision.


It will really help - if the reason reading is fatiguing, slow, etc is due to a muscle weakness.


This article isn't saying *you'd* be wasting your money, it says that Vision Therapy is successful for certain types of conditions and not for others. There are, from what I understand, behavioral optometrists that will try to sell it as a cure for anything, and it's not. It is, however, a very effective treatment for some types of vision disorders, some of which have symptoms similar to what you've posted re your dd.

When we were first referred for vision therapy, I was very skeptical - but I'd also known another mom whose dd had been through VT so I asked her about her experience, and it was very *very* positive. It still sounded like hocus pocus to me, so I asked our regular eye dr (our dd had just been through an exam with the regular eye dr and was found to have 20/20 eyesight). I was *floored* when our regular eye dr told us vision therapy (and the eye dr who'd been recommended by the neuropsych) is a very real and often beneficial treatment and that it would catch things that she never looked at in her exams. A regular eye dr looks at the vision in each eye, but a behavioral optometrist looks at how the eyes work *together*. According to our eye dr, if the eyes aren't working together and it's due to muscle weakness, VT can help in many cases. If it's due to a neurological challenge (as in the case of an LD), VT isn't going to help.


I'm really sorry your insurance won't cover it. Our insurance did cover it... and yes, the expense did add up. A few things you might consider: the initial evaluation was not hugely expensive and we learned so much from just knowing what our dd's vision issues were - if you can swing an evaluation it might give you good info. Another thought - our dd's VT office treated clients who lived far away and couldn't come in for weekly (or even monthly) therapy, so they would come in and the parents would learn how to do the exercises and then do everything at home - only visiting the office a few times per year. This kept costs way down. Kids who do VT usually have daily exercises to do at home anyway - it's not the kind of therapy you go in once a week for and forget about until the next visit.


How many people do you know who've been in for evals? Do you have a gut feeling that there wasn't really an issue or do you think they were scammed? I tend to wonder about the "nationally known" part - a good behavioral optometrist wouldn't necessarily have to be nationally known - so why are they nationally known? Is it due to their work or due to self-promotion?[/quote]

I would ask my regular eye dr who he/she would recommend for a vision processing evaluation. I would also check to see if they are a member of the organization our dr belongs to (which I can't remember the name of right now lol! - I'll look it up).

FWIW, we were curious if our ds also had minor vision challenges after the success our dd had with VT, because when he learned to read he also read very slowly, seemed to not recognize easy words, and held his head and eyes at really weird angles as he read, plus complained about his eyes being tired and not being able to read the board. He went through an initial evaluation by the same VT drs office and.... was found to have no visual challenges at all. Our dd otoh - we watched while she was going through her eval and that's when all my skepticism faded. About halfway through the exam she was asked a question and her answer totally floored me... and it was as obvious from that as daylight is obvious that she had double vision... yet we'd *never* had a clue at home, other than her fatigue and dislike of reading. Once we knew about it, we could see other signs that weren't as obvious.

I hope some of that helps -

polarbear

My DS8 does exactly the same thing! He has strabismus as well as a language processing disorder, and sometimes it's hard to pinpoint which issue is causing which problem. His version of strabismus is more of an "over" convergence - if he looks up or to the side sometimes one of his eyes will roll too far into the corner.

His reading is interesting. Sometimes he'll do exactly as you describe your son doing, and other times he'll fly effortlessly through reading (2-3 grade levels above).

Not sure yet if it's an eye fatigue issue, his ADHD kicking in, or the language processing, but he's either hot or cold. He'll sometimes start off great and then burn out. Other times he'll start off struggling through a "warm up" period then becomes fluent (as in, reading problems? What reading problems?) ...but then burns out and doesn't want to read anymore. I don't push him. I just have him do what he can, and he is getting better.

I've found that smaller reading sessions more often are the trick with him so he still gets the language exposure but he's able to take the frequent breaks that he needs.

The "nationally known" guy I mentioned is well known b/c he is listed as an expert on many articles regarding convergence insufficiency/vision therapy & b/c he's the author of a lot of publications about the same.

I, personally, know five people who've done vision therapy. I only know two well. One of them went through this years and years ago with her son (he's my age, so things may have changed a lot). She said that it was helpful, but that the results faded over time. The second has a child similar in age to mine. At the time, she thought that it was helpful as well but a few years later felt that it had made no difference for her child. I, honestly, can't recall who the woman with the child closer in age to mine saw for diagnosis and treatment of her child.

Wow interesting CCN! My guys isn't ever reading 2-3 grade levels above (he does read almost one grade level above according to the WIAT). But we have the same experience where he is often "either hot or cold" as well. He'll sometimes start off great and then burn out, just like your guy. Other times he'll start off struggling through a "warm up" period then becomes more fluent ...but then burns out and doesn't want to read anymore. We have the same thing! I have to say this experience has been leveling out lately in that he's seems more and more consistent. He's not totally consistent right now but definitely improvement -it seems like we're getting there.

Keep in mind this is just my estimation based on the scholastic reading level ratings of the books he'll read - it's not based on formal testing.

He's 8, going into grade 3, and he'll read books that are in the 5/6 range. This is mostly because pictures are so distracting for him, lol. If there is any kind of illustration he's all over it, talking about it, asking questions... but if I get him a chapter book with no pics, he'll just read (until his eyes burn out). Now that I'm typing this I'm wondering how much more he could read of a grade 3 book before he burns out - if he'd just read the darn thing ;-) Maybe I could cover up the pictures... lol

Oh my goodness - our kids should meet LOL ... mine is annoying about the pictures, too... same thing distracted by the pictures, likes to figure out which character illustration is which and adding extra things based on the picture...

LOL

Have you tried no-picture chapter books? (How old is your son?) I keep my finger under each word as mine reads, or we'll put a piece of paper over the text below what he's reading to cover it so his eyes aren't overwhelmed. This seems to help.

I've thought about "large print" books too (you know, large print novels - not kid books - to ease his eyes but still expose him to the advanced vocab & grammer) but I haven't seen any with appropriate subject matter (the ones I've seen at the library are too adult). I haven't really delved into this though... I could check on-line but haven't yet.

My DS is 6 but will be 7 in a few weeks. He is going into 1st grade (September birthday missed cutoff)

He devours chapter books, that is when someone else reads them to him ... He is immediately put off by so many words, so small on a page. It's why I regret waiting so long on VT - his confidence has suffered ... he's just beginning to realize he's getting better - that now that he is capable of more.

I keep my finger under each word as mine reads, as well...

I am thinking of getting him his books on CD (like you said for the vocab, grammer, etc) ... He'd have me read to him all the time if I could. He loves the Daniel X series by James Patterson and I just bought him one of the Danger Boy series.

This is interesting (I'm learning so much from you all... thank you )

DS8 took the WISC-IV once (at 7) and his block design score was 12, "average" even with his strabismus. Hmm.

That's awesome though - your DS has a content-devouring brain

My DS8(ADHD), meanwhile, often loses track of what's happening if someone reads to him (his mind wanders, although this can depend on the book). He's either engaged and constantly interrupting and asking questions, or he's quiet and then will suddenly say "wait a minute - what is this about again?" The only way he can keep track of what the text is about is if he reads it himself, out loud.

He's incredibly imaginative - sometimes he'll tell us he doesn't want to talk because "I'm imagining! Please be quiet!" ...but it interferes with his focus unless the story being read is more interesting than what's going on inside his brain. (This sheds a huge light on his attention difficulties at school )

Fascinating to follow these; especially on top of having read "The Dyslexic Advantage" and finding many, many similar traits in myself and DS6 intersecting with the "Lazy Eye" issues.

FWIW (in case this offers any strategies for others) I have always sub-vocalized as I've read, it's in my head but when it's noisy/distracting I can feel my vocal chords also working. I've tried to read without, but my eyes dart everywhere. But the pace gives me time to deeply understand and "world build" as I read. I've tried using the Kindle's text to speech, but I can't follow unless I also doodle, but I can listen to books on tape while driving.

I've set up a basic eye exam with the local developmental optometrist and wanted any feedback. So, my insurance vision coverage will cover a basic exam with only a $10 co-pay and this guy is on the list of in network providers for that. He is not in network for medical (it's complicated). His office tells me that he can tell if dd11 has convergence insufficiency, etc. from just the regular basic eye exam that the insurance will cover. If so, then he'd need to do another eval for $390 that insurance will not cover (it becomes a medical issue at that point). The second eval will determine whether vision therapy will help/what she needs.

They tell me that vision therapy would run about $2100/three months. I did ask whether he'd be able to objectively distinguish btwn a neurological functioning issue like dyslexia vs a mechanical issue like convergence insufficiency with the initial exam and they said yes.

Their website says that they provide therapy for both (i.e. - it sounds like they provide vision therapy for dyslexia, AD/HD, LDs as well as convergence issues). I'm disinclined to seek the second more expensive round of vision testing or vision therapy if the issue seems to be more LD/dyslexia related. Dh is convinced that they're going to tell me that she has convergence issues regardless of what they find.

Thoughts on any of this?

eta: one other thought. There is a general "eye center" clinic in town that has one OD on staff and that also lists vision therapy as among their services, but it seems to be a much, much smaller part of their practice than the place where we have the apt. I'm second guessing and wondering if we should just go there and have the routine exam done mentioning the questions we have re convergence insufficiency and see what they find. I'm wondering if a place that doesn't specialize in this type of work might be less capable of finding a problem but also less likely to find a false positive.

Sorry that I'm a bit late to this discussion. Busy weekend.

I skimmed the thread so forgive me if I am repeating anything. We did go the vision therapy route. It did help with my DD's headaches, tracking and issues with words "running off the page." See this website for simulations of these problems:
http://www.childrensvision.com/reading.htm
I believe that these are the kinds of things that VT can help address. I tried to have DD look at that site and tell me whether she ever experienced anything like this. Unfortunately, she couldn't articulate what kinds of issues she had been having until after she had gone through VT and seen some improvement.

I understand your reluctance to rely on the VT folks to give you an accurate assessment re whether your DD could benefit from their services. We got lucky and found an optometrist who did not provide vision therapy who gave us our initial evaluation. She told us that DD had convergence issues that were just outside of the normal range. She told us that DD might benefit from VT but that it was not a slam dunk. We decided at that point to get a full assessment from the VT folks. Any chance that you could have an independent optometrist assess her convergence?

BTW, we never expected a "cure" for her dyslexia. I thought these claims were hogwash and still do. Still, the vision therapists persist in making these types of claims. I really wish that they would rethink this approach.

Also, re the block design correlation. My DD went into the extended norms before vision therapy. We haven't had her retested since. Still, it's hard to argue that it significantly affected her ability to perform on that portion of the WISC.

I think that we crossed posts. I also wanted to mention that we paid about $90 per session -- I seem to remember that there was a break if you paid for 10 sessions at the same time. We went once a week and had a lot of exercises at home. BTW, those exercises were a huge battle to get done. Anyway, I think that ours was less expensive and we are sort of in the same market. You may want to shop around re price if you decide to go that route.

See, so both the places I have gone make pretty clear that VT doesn't treat dyslexia. I feel pretty lucky, I must be goign to pretty decent/upfront places.


I am sure it depends on what type of problem and the severity. I am sure your daughter's issues, while perhaps similar, are not the same as my son's.

Our VT dr was also very up front about this, as well as our regular eye dr. However I think it's worth noting that I've "met" several parents online who's children are dyslexic and who have benefited from vision therapy; I think that what happens is that it's not unusual for some children to be dyslexic and also have visual challenges - so VT isn't curing the dyslexia, but it is helping the children with another area of challenge. It's been quite a few months since I read Dyslexic Advantage, but I think that the Eides mention that issues with visual tracking are common among people who are dyslexic.

I personally wouldn't feel comfortable with a business that tried to claim VT will solve *everything* but for instance, our VT office will tell you this: They tell you that VT does not cure ADHD, but it can eliminate behaviors that *look* like ADHD, and this was true for our dd - before VT she never sat still in a chair, she had to eat standing up and she was always on the move. Her pediatrician was convinced she had ADHD because she literally bounced off the walls at her yearly dr appointments, when really she wasn't "bouncing around" due to ADHD, she was bouncing around because she couldn't focus her *eyes*.

I can understand your (Cricket's) dh's concern that anyone who goes in for an eval might come out being told they have convergence issues, but that's not going to happen with a reputable dr. And it's probably going to be hard to find someone who's been for an eval and found not to have an issue simply because most people don't go for this type of eval unless they have had some other professional refer them or had some reason for a parent to be concerned that there was an issue - i.e., the people who are going in for evals are likely to have something waiting to be found. If your dh is really concerned about it, and it's only a $10 co-pay, I'd seriously consider having another family member who you're *not* concerned about also go in for an eval

Re cost, our dd's VT (2 years ago) cost $3000 for 6 months of once-per-week office sessions (1 hour length). It was our choice to do once-per-week, we could have paid the same amount for 3 months of twice-per-week office sessions and the end result was supposed to be the same.

Someone above mentioned VT doesn't last - and we're finding that to be true for our dd - she's starting to have vision issues again, but my gut feeling is if we could get her to do her exercises she'd not have the loss of muscle tone and wouldn't be dealing with regression in vision. While it's true that the exercises are work and have to be done daily (our dd had to do them twice daily for quite a while) - they aren't *that* horribly terrible and some of them were even fun for a child.

polarbear

Yes, this is what I was told by both places I went to about my son's VT and what I was also told by an aquaintance who is a special tutor for children with reading challenges and dyslexia.

This really concerns me. I plan on asking about VT in conjunction with surgery to help maybe prevent this? I have no idea as I have not asked yet ... I touched on it briefly with one doc and she said we could talk about that (ie explore the idea of surgery in addition to the VT) but we haven't yet. Polarbear or anyone else - do you have any info on how to truly "fix" (aka get lasting results) the problem of strasbismus? Is surgery and therapy a way to get that or is this it? Is this a challenge that will keep coming back to haunt DS?

I gave a call to one friend who has done VT for her child to get her opinion and she felt that the dr we were considering initially was very aggressive and that she wouldn't recommend that route. She did also say that she's seen the same thing as above with the impact fading over time and her child needing to go back for more VT repeatedly. OTOH, she was generally positive and would recommend VT just a different doc (whose name I am going to edit out from above - lol).

marytheres, I don't know what we'll ultimately do for our dd - we're taking her back for another VT exam later this fall in hopes of convincing her it's worth it to keep at her exercises. What she'd need to do each day to keep her eyes "on track" really isn't a huge time-consuming deal, just a few simple exercises she could do as part of her schoolwork or when she's reading.

Some kids (and adults) with strabismus correct it with lenses. One of my nieces has pretty strong strabismus in one of her eyes (nowhere near as subtle as our dd has - in her case her eye is obviously pointing away from the other eye when not corrected). When she was in elementary school her dr gave her parents the choice of surgery or corrective lenses and they stuck with glasses (I can't remember exactly why).. and then when she was a teen she got a corrective contact lens, and it works *GREAT*.

polarbear

eta - in spite of my dd's vision apparently taking a step backward, I am still a firm believer in VT and would recommend it to anyone in the same position in a *heartbeat* - I have no regrets about the time/$ we spent for dd to go through it. It made a HUGE difference in her vision and even though she's losing some ground now, she's nowhere near in the same place she was before starting it.

Thanks for this polarbear. I really needed to hear this - good to know.

It's been three years for us and so far DD has not lost any ground as far as I can tell. I whole-heartedly agree that it was worth the time and effort for my DD. Prior to VT, getting her to sit down and read was a huge fight. Not a big surprise, since it gave her major headaches and eye-strain/fatigue. It's still not her first choice activity, but she doesn't hate it anymore. Occasionally, we even see her tuck herself in a corner with a book.

Oh this is good to hear. Thank you for sharing!

So I have been following this thread with interest because my DS doesnt fit neatly into any of the LD or VT categories but there's something going on.  He definitely has fine motor issues, and perhaps fine motor integration issues which make his handwriting a mess. We had one set of vision tests which identified a tracking issue but not a huge one. He has zero difficulty reading but clearly has something which makes the spacing of letters in words and between words so difficult for him. And someone - Polarbear? - mentioned the eating every meal standing up - wow is that famillar.  

We are waiting to set up the next level of vision testing for perceptual stuff and there some fight going on between eye doctors about the skills tests being necessary before the perceptual test and the doctor who did the first set of tests saying its not necessary. So I don't have the report yet which is driving me crazy because it is preventing me from having something to give to his 1st grade teacher about his vision and writing as an amendment to the IEP.

But, the reason why I chimed now  is the discussion sent me to my insurance carrier's policies to see what they said - wow - there's quite a fight going on being the AAP the AAO and other alphabets orgs dealing with vision, children etc. so my policy says, we pay for VT for these things, but not those things and expressly highlighted these studies regarding VTs ineffectiveness for dyslexia and other LDs. Most interesting for our situation was- they cite this - 
And then it goes on to say there is no discernible effect and blah blah blah not covered! I get that the n's are small.  But what is really interesting here was the fact that the evaluation can clearly identify deficits, so worth doing, but they can't determine outcomes of therapy as conclusively. But it seems to suggest that if reading is an issue the testing is valuable - the mixed response is about what can be done to remediate.  Doesn't help us as much since reading is not his issue and it's not just a core/strength issue but I found it interesting and thought I would share!

DeHe

Dehe - interesting!

As for your DS, my DS also has benign congenital hypotonia (apparently inherited frm my husband), which causes problems with core/strength and fine motor. Eating meals (or doing anything really) standing is a big tendency for my guy b/c it is somethign about sitting an holding posture that is really difficult b/c of the hypotonia. You may want to look into that. An OT can help but I don;t think they can diagnosis per se... A neurologist diagnosed by DS but all the OTs could tell me he had it easily and quickly. One thing that goes along with hypotonia is hypermobility (double jointedness) - my son can "click" his joints for example (creeps me out)... as he gets older, stronger does therapy his ability/tendency to "click" seems to be declining thank goodness but hypermobility, I believ goes hand in hand with hypotonia.

I had a conference with new vision doctor yesterday. I checked into a new one b/c the one we are with now is farther from me, much more traffic en route and has limited hours.

The new place is so much nicer.... it's bigger, better hours more therapists, therapist are really good with DS - young, etc.

Also, they gave DS more tests and sat me down for an hour conference (free of charge)to explain the results... the other place did not do the "conference" really. The other place was super nice and good too but this place is more .... I don't know... efficient? professional?

I am feeling so much better about it all. Alhough it so breaks my heart to see from the tests how much my poor DS was struggling to "see" (despite his 20/20 vision). They gave him visual spatial skills tests, visual analysis skills tests (visual memory he scored hgh and in visual discrimination he scored really really high!), they gave him visual motor integration tests including the BEERY. They wrote up all about each tests, DS' performance and what it means in a report for me and the school with some clear recommendations for the school about what DS needs. The doctor was very, very optomistic about the VT truly fixing my DS' problem - DS is like the type of case that is ideal for VT. This guy said DS would not be a a good canidate for surgery in his opinion.

I have to say DS' reading alone has imporved so much already. After two years of it being so laborious filled with angst, eye discomfort, and misery, yesterday he read an 18 page book - "The Tortious and The Hare" so fluently, easily and he actually enjoyed it... I can't believe it. Finally. Even he was like "is this real?!? I can finally read now?!?"

I made an appointment with a surgeon anyway - just to get yet another opinon. The surgeon is recommended by a neighbor whose child (same age as my DS) had surgery last year for intermittent exotropia. They felt they had no choice but surgery. I definitely plan to stick with the vision therapy for now as it seems to be helping tremendously and the prognosis is so good. However, I like to research things thoroughly and so I do want at least have the surgeon's thoughts and opinons... Current doc said that he is pretty sure the surgeon will not recommend my DS for surgery, though.

I am feeling so relieved and optomistic. The doctor and therapist that evaluated my DS were so impressed with his intelligence... they really had may many good things to say about him and said he was a real pleasure to work with (his other VTs say this too). They all got a big kick out of him. Which is so nice to hear since all school year I hear a lot of negative comments about him. Maybe that will change now with this problem being identified and addessed.

I'm leaning toward setting up an apt with someone different than the more "aggressive" developmental OD I was originally planning to have dd see b/c I'm hearing from more than one person that he is inclined to push VT for everyone no matter how small the problem or whether it is LD based or mechanically based.

However, I have one question to see what you all think. One place we could go and have the "routine exam" covered by insurance is a more traditional eye center (sees people for regular glasses, more opthamologists on staff than the one OD, etc.). What they tell me is that their one OD can test for convergence insufficiency as part of the regular exam, but if that's what it is, it would no longer be considered a routine exam and would, therefore, no longer be covered by our vision plan: it would go to our medical plan where we'd likely wind up playing most of the $285 cost.

I guess that was a sidetrack, not my question, lol! Anyway, so here it is:

Do you think that ANY OD could dx convergence insufficiency as well as any other. In other words, is it an objective diagnosis? I suspect that this guy would be a lot less likely to see something that isn't there or push for treatment of a very minor problem that isn't likely causing all of the issues we're seeing, but don't know if that also means that he'd be less likely to catch a problem.

From what the office says, he doesn't do VT himself, but can refer you to someone else for it or get you set up with a computer program for VT.

I think so ... I think the diagnosis is objective but the OD needs to give the tests, which is why a basic vision test doesn't catch problems. However, perhaps the problem comes with the OD knowing (and willing) to give the battery of tests, ykim? Anyway, that's just my gut reaction not expert or substantiated in any way really (obviously). Except that, during my son's initial developmental tests I could "see" his disability quite clearly - like, all he needed was to be given the test. Having said that, the new place I went gave several more tests (obviously) - like the Berry, etc... where more valuable information was revealed about what exactly DS eyes are doing, when and his visual processing. However, my understanding is that those tests aren't really given automatically - I think they are only given when the diagnosis/problem is found. This new place touts sort-of a more complete (for lack of a better word) approach - they refer out to neuropsychs, do dyslexia screenings, etc. The feeling there is "we can give you visual info and diagnosis and we can point you in the right direction if that is not your child's problem or if there are additional challneges we think are present." In my case, they believe that additional LDs are not present, that DS' problems are completely physical/visual (eyes over-crossing intermittently causing tracking, sequencing problems, etc.) One of the neuropsychs I know they refer to is listed on the Hoagies website and has a great rep for LDs.


Anyway, not sure how much that helps you. I wish you live din my area. I feel like this second/new place I went would be a really good place for you ...

I have a friend/acquaintance who is an OD, I could try to ask her if you like?

What, exactly, did they do during this test? The other office I mentioned had the OD's assistant ask the OD himself as to whether a routine exam could pick up convergence insufficiency and what they told me he said was the there was "another test" he could do during the routine exam that would pick it up. I guess that I'm wanting to know what this other test ought to be.

Sure, that would be great if you have the time. Thanks .

Hi! Okay I talked to the woamn that I know who is an OD about Your questions Cricket2. Here is what she said:

"The question as to who can diagnose CI is a little tricky. Yes, we are all legally able to diagnose it and we are taught it in school. It is a relatively objective set of tests. However, the average eye doctor probably diagnoses CI or other VT issues maybe once or twice a year when it's a patient with crossed eyes or obvious headaches and double vision when reading. The rest of the time, they just don't do the tests that would uncover the problem. They really don't.

Now if she specifically went in there and said "I think my child has convergence insufficiency and I would like you to test for it", they could manage to do a test or two. The one that's most relevant is called the "Near Point of Convergence" or NPC. That's when we bring a shiny ball (or sometimes a pen or toy) slowly up toward the patient's nose and have them follow it in closer with both eyes together, watching for one eye to lose grasp and listening whether the patient gets double vision. There are also other tests of their eye positioning and ability to handle a convergence demand. The NPC is the most basic and easiest to do, so that's probably the other test the doctor was going to add on.

But honestly, why not go to a doctor that actually treats the problem to make the diagnosis? It's the same co-payment."

I hope that helps you Cricket! I may private message to make sure you get the info...

I think that my main reason on "why not" is that I am hearing from others that the drs who actually treat this type of problem regularly also tend to over-diagnose and b/c, from what the one guy's office tells me, if they see a likely problem in the regular exam, they'll suggest a second $385 exam, that isn't covered by insurance, to confirm and in order to recommend treatment.

Oh great you saw this info!


Oh yes, sorry, I understand that! I just cut and copied her email to me (and I hadn't included any info on you being concerned about over-diagnosis in my original email) ... I wonder what she would say if I explained that to her... She feels strongly about diagnosing these conditions, though, she feels they are missed so much and cause so many unnecessary problems so I wouldn't want to come off like I think it's a scam or whatever. But anyway, yes I get and understand your concerns!