Gifted Issues Discussion homepage Forums Twice Exceptional Vision Therapy -Not seeing any differences

Could it be a disorder like dysgraphia? DS has messy handwriting as well and has developmental coordination disorder.

DS's neuropsych (with a large university) did NOT recommend VT, said the research does not back it up. I thought that was kind of overboard harsh considering that his eyes were quite obviously crossed for several months due to brain damage (but maybe VT has little chance of helping in that circumstance anyway). The only person that "pushed" VT, was his OT. Neither opthamologist did (one was a neuro-opthamologist) nor the neuropsych. I think there are probably some legitimate cases where it might help, but I also think that convergence issues are probably way over-diagnosed by people specializing in VT.

I spoke to my DS's doctor about VT, he said he has seen it work a couple of times, but far more often it doesn't work. He wasn't sure why it did work in the situations that it did. When I read further it appears to be good for a couple of conditions, but often people think VT is a silver bullet and it will fix things that it won't fix.

I called one VT in my area, and I asked the person who answered how often they find problems when they do the initial evaluation, and she implied they always found problems….so that put me off. Statistically it doesn't make sense that they would always find problems...

Black cat has a good point ... My DS still had dysgraphia ... But never expected VT to help much was that.

DD8 started VT in July, and we are about halfway through. There is no doubt the whole process is a bit more of a leap of faith than I am comfortable with. However, there is some decent evidence plus solid expert opinion backing VT, under the right, very specific conditions. In other words, the right diagnosis (primary problem is convergence insufficiency) addressed by an experienced therapist, using appropriate approaches. That last bit is especially tricky, as there no doubt VT is still art not science (and teeters into voodoo some days). There is lots of snake oil out there, and probably even more well-meaning but inadequately experienced people claiming to solve the world's problems with VT. I have made the decision to trust the optometrist, based on his education, experience, references, and the consistency of his reccomendations with best practices.

Has your optometrist been able to define for you exactly what the problem is, and where you should and shouldn't expect to see differences when you are done? Or at least, after 10-12 weeks, which if I remember correctly is the point at which most evidence suggests some effect should be found? I wouldn't expect much at four weeks, even under the best of circumstances.

So now we live with our decision to trust the optometrist, but it's not easy, because in our case we may never have a clue if it works. DD herself swears it's making no difference - but the exercises hurt and she hates doing them, and she is unfortunately a well-recognized unreliable witness for this kind of thing. I can say that she is becoming better at doing all sorts of things through her daily exercises - and that it is often surprising, and sometimes disturbing, to see what she can't do. However, I truly cannot say how/ if any of these changes will result in meaningful functional improvements in real life. (I have to think it must be helpful in some way, though, that her eyes can now both follow the same object at the same time without one having a mind of it's own, not to mention they both now track something coming at her face instead of flying out sideways. Good for shooing away bugs, at the least! )

The main reason we may never have a clue if it works is that DD's biggest issue is reading, but she's also dyslexic and we've been remediating the heck out of her reading, with extra intensity over the summer. Her reading has gone through the roof (aside: YEAH!!!!!!! it's so awesome!!!!!!!!!!!). Is the VT helping? No idea. I don't have a clue how we could ever know. I think - I hope? - it's probably helping, by reducing fatigue and making fluency easier to attain/ maintain, but there's no way to untangle the two. I do notice she seems to find it much easier to keep track when she reads, not lose her place or skip lines. Maybe that's the VT contribution. Maybe it isn't though.

And if we hadn't also been remediating the dyslexia, we probably still wouldn't have seen any improvements, since her reading would still have been abysmal, even if she could follow the lines and see better.

So, my point, in all this rambling: it's critical to know, comprehensively, what are all the issues you are dealing with, because VT can only help in one specific area (visual processing, particularly convergence insufficiency). If your DS is affected by additional issues (fine motor, dysgraphia or anything else), it may be really hard to see change, even if the VT is highly effective. For us, our best hope is that the VT is making the other remediation easier and less painful than it would otherwise be - but it doesn't reduce any of the need for other remediation. I remain comfortable with our decision to trust this optometrist and stick with it. I won't deny, through, that it's unbelievably frustrating to spend this kind of money and never really know if it's helping. I am evidence-girl, and it hurts me to my soul to take this on faith. But I do, honestly believe it's helping DD, and is money well spent. But dang, I wish I could measure it!

I guess we were lucky - DD was prescribed reading glasses at the first eval. The first day with these glasses her reading teacher (daily Wilson intervention for dyslexia) measured that she went from 59 wpm to 81 wpm. This told me the optometrist had correctly identified her issues. I was told that the goal was to make these glasses unnecessary.

We did VT twice a week in the vision gym plus did the homework every day she didn't go in. She didn't like the excercises but did them without compliant because she wanted this to work. Within a few weeks we started to notice that the excercises were getting easier the more she did them. An excercises that was very difficult for her on Monday was much easier by the weekend. The excercises were changed each week and I was told what they were supposed to be addressing but I was a bit skeptical. We buckled in and ready to ride but not sure where we were going to end up.

They explained that over the course of her life DD had developed a whole host of compensatory strategies and the first weeks/months of VT would be spent undoing these. The older a kid is the more compensation has to be undone. About 8 weeks in DD noticed a change. She was doing an excercise with a white balloon wearing glasses with one red lens and one green lens. She could tell which eye was "on" by what color the balloon looked. All of a sudden she realized the balloon was brown - she was seeing it through both colors at the same time. After this I think the excercises became more complex. She made a ton of progress and they called her their "top student".

After 3 months the optometrist said DD gone from 20/32 in one eye and 20/40 in the other to 20/20 in both (this result was confirmed on a recent pediatrician visit). Optometrist rattled off a whole list of improvements and said prior visual perception testing was not valid because DD "couldn't see the page." She had her staff do a visual perception eval which did not seem to reflect the same level of improvement but since DD had scored in the 1st percentile 7 months earlier even things measuring in the 8th or 10th percentile were indeed improvements.

As I posted here we stopped VT suddenly after 17 weeks when I became uncomfortable with some billing practices. That same nagging concern over snake oil and taking advantage of desperate parents mentioned by others up thread was buzzing in my head. DD has continued to do VT excercises in the month and a half since we stopped going to the vision gym but the excercises have become so easy for her it hardly seems worth the time to do them. Interestingly she has decided she no longer needs the reading glasses at all. And for the first time in her life she is voluntarily reading. Quite frequently in fact. Going back to the reading teacher's measurement the first day with her glasses we know that she has improved at least 40% or so. And yes DD is dyslexic. For the first time ever she no longer confuses her lower case "b" and "d".

Not sure if this answers your questions but hopefully it helps to map out a success story.

Something that has me tripped up, as a person lacking binocular vision, is knowing just what IS normal, what should be expected. My skepticism kicks in when I think, well, is he not doing well on that evaluation because it's within the parameters of normal, or is he actually having trouble, as it appears? I personally cannot do those convergence things. So I'm watching the eval and thinking with a questioning mindset, does he understand the directions? Is the evaluation accurate? How experienced is the assistant performing the tests for the doctor, if one of the tests was totally confusing and I could tell DS was really irritated by the instructions? And how about those bifocals, how do they impact the tests vs single vision lenses? Questions I need to ask the doctor.

DS clearly has convergence issues, and alternates his eyes near, and his visual processing is visibly slower than his auditory processing. But he compensates well. How do you determine if it's just a natural weakness, visual processing, that you cannot change and need to accept and move on? Is the only way to know to try the VT?

DS was never evaluated for Dysgraphia,I feel there is not enough symptoms pointing to dysgraphia, or would like to wait until we see some progress with the VT. His handwriting is messy but the main problem is the neatness and spacing. His spelling is excellent and there is no letter omitting and reversing issues. In terms of vision processign issues, he has problems with convergence, tracking and focusing (accomodative). The 1.5 hour vision processing test did not find further problems.

During the parent meeting with the first VT, she suggested therapy would help but he might be able to grow out of it. She was very ambiguous and noncommital. However, in her written report that sent home a few days later, she clearly said he has deficiencyies in 3 of the 4 areas tested and recommended twice a week therapy. We were utterly confused about the inconsistency and went for the second VT. Equally reputable in our area, the second VT offered a quick screening and confirmed his convergence and focusing issues, plus tracking. The first VT never said DS had tracking issue. The entire process did not help us to gain more confidence in Vision Therapy. Increasingly we felt like they jsut wanted to make money from the expensive evaluation and screening sessions.

We still decided to give VT a try for at least 3 months, as we hear so many sucess stories and do not want to regret later.

DS is cooportive with daily practices but told me there have been no differences at all. It is really a leap of faith to keep spending money and time on something no evidence indicates is working.
like most of you have suggested, we will give it a few more weeks, until the entire first phase of 12 weeks.

Glad to hear sucess story like yours. I do see sutle chanegs in the daily exercise with block string. He is now able to see the "x" for each of the beads, whereas in the beginning he can only do that for the nearest three beads.

[quote=longcut] My skepticism kicks in when I think, well, is he not doing well on that evaluation because it's within the parameters of normal, or is he actually having trouble, as it appears? I personally cannot do those convergence things. So I'm watching the eval and thinking with a questioning mindset, does he understand the directions? Is the evaluation accurate? How experienced is the assistant performing the tests for the doctor, if one of the tests was totally confusing and I could tell DS was really irritated by the instructions? And how about those bifocals, how do they impact the tests vs single vision lenses? Questions I need to ask the doctor.

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I had similar doubts during the screening. She explained to me after the exam that the easist way to tell if a child has convergence issue is to use pencil pushup. I did it right when we got home and DS was able to converge. I called the VT to ask if his issue is "real", she said" oh, good for him, when I tested him, he wasn't able to do that and there are other methods we use for the evaluation as well. But your son is really smart and he learns what your expectation is quickly and he does that for you"

We were going to quit after this conversation then DH insisted we had a second opinion. His reasoning is that the focusing issue (near-far focusing)was found out by our regular vision doctor in the summer, although for whatever reason, it was never noticed in the previosu 4/5 years of annual check up. He thought the regular vision doctor would have no bias.

We are on our fifth week of VT for double vision, focusing, and eye teaming. DD is 9, so our situations sound similar. We were only initially assigned 12 weeks of therapy, so her case isn't as complicated as some, but she does have double vision, words moving on the page, headaches, fatigue, etc. I keep asking her if she has noticed these issues lately, and she says no, but I don't know if she is just saying that so I will leave her alone
Just this week, I noticed better posture when writing and less mental fatigue. She is having an easier time with the VT homework. She bounced a small ball off the wall and caught it nine times in row. For her that is a huge accomplishment, and it took some of the sting out of the money being spent. We have been diligent about the homework, but seeing some progress and her confidence rise sure helps us stay motivated.
I am still concerned that she has other undiagnosed issues, so I need to figure out if further testing is needed. The VT practice did say they would conduct additional testing or refer us if they feel it is needed after her 10 week check up.