Opthamologists vs Optometrists for kid's reading 'issues'

mary_228April 12, 2006

Love to have some of your perspectives on this topic, as I am sure others here have been "there" before me!

After a visit to an optometrist at Costco, who gave a very thorough exam with dilation, etc, we have discovered that DD, aged 10, has "convergence insufficiency". This means when looking a smallish text, some letters sort of float off and the proper order cannot be discerned. This also seems to affect her math. Great concentration is needed to straighten all this out in her mind, with the result that she "hates" to read, makes many errors (esp when reading the instructions) and it even affects her ability to catch a ball (doesn't bring her hands together). Oddly, she can play piano like nobody's business! She also is a good student, well behaved in the classroom, volunteers to read aloud in every class, does her homework without parental involvement, etc. So basically, we really weren't aware of a "problem" and DD never complained of this, thinking that this is what everyone else saw when they looked at a paper.

Referral to an optomentrist for Vision Therapy has been met with skepticism by the primary care doc (will give referral to pediatric opthamologist instead), and in any event, these services are not covered by insurance. She does not need corrective lenses.

Anyone been there, done that? It seems that these two types of eye professionals have very different orientations and training. I hate to put DD through another eye exam if the opthamologist will have no other ideas than "pencil push-ups"!

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My understanging of opthamologist vs. optometrist seems rather basic -- that an optometrist determines basic visual problems, tests for things such as glaucoma, looks into the eye for eye health, etc. -- prescribes corrective lenses -- deals more with non-complex issues.
When a situation presents itself for more in-depth care, I think this is where an opthamologist comes into play. They might be more possibly equipped to deal with eye exercises, etc. In our situation, DS was a preemie, and automatically referred to pediatric opthamologists shortly after birth. His vision wasn't affected at all by his prematurity, but nonetheless, he was followed at a ped. opthamology clinic for several years.

If you have faith in your primary doc, I think I'd go along with his recommendation.

Has anyone given any indication of what might be done to correct the situation?? How frustrating for your daughter to have to deal with all of this !!! Bless her heart !!

Good luck with it all !!

    Bookmark   April 12, 2006 at 10:14AM
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Hurray for Costco! That was a very thorough exam, and you're lucky to have caught the problem at all. Both of my sons had several early eye exams that failed to catch any problems, though both had several behaviors that indicated very strongly that they weren't seeing well -- strongly enough that several teachers asked that we have their eyes checked.

"Referral to an optomentrist for Vision Therapy has been met with skepticism by the primary care doc (will give referral to pediatric opthamologist instead), and in any event, these services are not covered by insurance. She does not need corrective lenses. "

This doesn't really surprise me... Vision Therapy seems to fall a bit too close to the 'alternative' camp for most primary care doctors. As a rule, they're not familiar with it, so they don't believe in it. However the American Academy of Optometry (AAO), the American Optometric Association (AOA) and the College of Optometrists in Vision Development have all issued statements supporting Vision Therapy when performed by trained Optometrists following accepted protocals. This is NOT the same thing as 'regular' eye strengthening exercises or DIY computer programs you can follow at home.

My older son had convergence insufficiency and visual tracking difficulties. (But 20/20 vision) His right eye and left eye tracked separately when reading text, which would cause him to read scattered words 3-5 lines below where he was 'mostly' reading. He also had trouble with rapid shifting between near and far vision -- a problem which makes taking notes in class exceedingly difficult. After one 6-week course of Vision Therapy, his reading improved tremendously, and he was able to read comfortably for much longer stretches of time. A repeat visiograph (a graph that tracks eye movements) showed that his eyes now worked together, and annual follow up exams have shown that the improvements have been retained. Perhaps most convincingly, I overheard him talking to a friend about it near the end of his treatment -- complaining actually, because he would have to miss a party. When his friend asked what Vision Therapy was, DS explained that it was exercises to help him see better, and that while it was 'boooo-ring' (he was 13), that it really was helping and he could tell a difference.

My younger son had/has much more extensive visual problems. In fact, his vision, though almost 20/20, was so dysfunctional that his brain had started to tune out visual input -- he wouldn't even 'bother' to focus his eyes much of the time. He needed a much longer course of Vision Therapy -- close to two years. But it's helped bring his vision along to where it's now one of his stronger areas.

You'll want to find a Vision Therapist with a good reputation in your area. If you can find any parent support groups for kids with dyslexia, autism or ADHD (all disabilities where vision therapy can be very helpful), they may be able to refer you to someone good or tell you who to avoid. There are also links to qualified providers on some of the web sites about Vision Therapy.

It's unfortunate that most insurance plans don't cover vision therapy. But you may find it's the best money you ever spent for your child's education. (For our older son, it has been.)

Here is a link that might be useful: Vision Therapy

    Bookmark   April 12, 2006 at 10:45AM
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Thank you Sweeby for the testimonial. I've been to the website you linked and found the information and success stories fascinating but obviously listed because they ARE success stories and they could, of course, be entirely fabricated! How did you find our about your sons' vision problems and get in touch with VT practitioners?

I was very impressed by the young OD at Costco, and not because I have had lot of eye doctor visits (just old age related reading glasses). He worked so well with DD, explaining what what going to happen next, etc. He referred me to another OD with the proper training in this field who is in the next suburb, no less. And we're fortunate to have the resources to pay for this care on our own.

Do you think we should use the ped opthomologist referral (and put DD thourgh the tests again) or just go ahead with what the first guy told us? I have a call into the VT OD inquiring if they have had any opthamologists who supervise VT care, possibly gaining reimbursement for us (ok, doubtful). I can choose which opthomologist to see as long as they are in the network.

    Bookmark   April 12, 2006 at 3:58PM
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I tried vision therapy for my son. It was not really successful for him. I went to the doctor who was most highly recommended in my state, spent lots of time on exercises and money on uncovered expenses, and really saw no results. So perhaps it's a hit or miss thing.

FWIW, the neuropsychologist who is currently testing my son said that she thinks it's voodoo science. I understand that doctors and alternative therapies don't usually mix well. I guess I just wanted to warn that YMMV.

    Bookmark   April 12, 2006 at 4:07PM
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I hear you Mary -- I'm a bit of a skeptic also about 'voodoo science' and alternative treatments, and don't try them without a good bit of research first. But then again, for the issues my son has, there are no accepted medical treatments except psychiatric drugs which, IMO, he doesn't need. Some of the alternative stuff appears to have helped, some has not... Definitely look at information from people who have nothing to sell. The site I linked to is not one of those -- my bad. They do exist. There are also sites (Opth mainly) that don't agree, and you should read those also to see how they solve your DD's porblems.

One of the decision criteria I always use when evaluating a potential therapy is the "What is the potential harm?" test, which is one of the reasons I decided to try VT (no real potential for harm) and *not* try others.

We first found out about VT at the University of Houston College of Optometry. One of their teaching professors specializes in kids with LDs and developmental differences, and was recommended for that reason. He's the one who first recommended VT for DS#2. I did not pursue it at the time (voodoo concerns, priorities), but came back to it later after hearing some of the mothers at my son's school discussing the results they got with their kids. DS#2's teacher suggested it specifically after watching him struggle in math. He could count pennies (large and movable) but not dots on a page; he would turn his head sideways a bit when reading, and would turn his head to see things rather than moving his eyes. DS#1's dyslexia tutor also recommended seeing a "behavioral optometrist" for #1 after observing his work habits. So I scheduled 'regular' eye exams in place of their annual vision checkups. After seeing how much more thorough the eye exams were than the 'regular' exams both boys had already had, I decided to give VT a try.

The trouble with your Ped's approach is that if the guy he recommended doesn't believe in that particular type of 'voodoo', then he's unlikely to see the same vision problems the Costco OD saw, real or not. (Did any of the other ODs or Opth's your DD saw even test for convergence insufficiency? And you'll have gone through a whole additional round of tests with no real solutions prescribed. Of course, an OD who does believe in Vision Therapy may tend to see 'problems' where other OD's or Opth's won't. You just have to decide where to put your trust.

You wrote "This means when looking a smallish text, some letters sort of float off and the proper order cannot be discerned. This also seems to affect her math. Great concentration is needed to straighten all this out in her mind, with the result that she "hates" to read, makes many errors (esp. when reading the instructions) and it even affects her ability to catch a ball (doesn't bring her hands together). " You just need to decide if these problems are 'real and serious' or if they're voodoo.

Here's an abstract from a December 2005 study published in the American Academy of Optometry journal about the efficacy of treating convergence insufficiency using a variety of methods:

Program Number 050019
Author Scheiman, Mitchell (Pennsylvania College of Optometry)
Coauthor(s) G. Lynn Mitchell (Ohio State University), CITT Group
Topic Binocular Vision
Day Thursday, December 08, 2005
Time 4:45 PM-5:00 PM
Room Room 1A-B
Abstract PURPOSE: The Convergence Insufficiency Treatment Trial (CITT) study group completed two separate studies comparing treatment modalities for symptomatic convergence insufficiency (CI) in children ages 9 to ----------------------------------------

    Bookmark   April 12, 2006 at 5:11PM
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I would go to the pediatric opthamologist to get a second opinion and then decide what to do. I really think that you need a second opinion.

    Bookmark   April 13, 2006 at 12:20PM
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I haven't read what others wrote as I only have a minute.

my ds who is now 13 went to a developmental optometrist for 6 months back when he was 9-10. He had trouble with over-convergence, mid-line jump and switching his focus from near to far. He was as good reader, but was always getting headaches or blurry eyes--pressing on his eyes with the heels of his hands. He could not catch a ball (he used to duck at fly balls). He had worn glasses for a few years, but his regular optometrist never saw these other problems...

Tested by school OT, his visual processing speed was in the 5%ile while all other visual tasks were in the 90+%ile.

He had weekly office visits, and "homework" exercises that I made him do 5-7 nights a week. after 6 months, when he was tested again, his processing speed increased to the 50%ile...headaches were gone, and he even made a few good outs on his baseball team...a lot of the exercises had an OT component to them, making him cross the midline, or combining movement with vision...

I've worn glasses for 35 years and his bev. optometrist did tests that I have never seen before--and I've been to tons of opthamalagists and optometrists (even Mass. Eye and Ear).

feel free to email me--I forget where you live, but I havea great recommend in MA...an lots of connections through a list...

    Bookmark   April 13, 2006 at 1:40PM
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My understanging of opthamologist vs. optometrist seems rather basic -- that an optometrist determines basic visual problems, tests for things such as glaucoma, looks into the eye for eye health, etc. -- prescribes corrective lenses -- deals more with non-complex issues.

The basic fundamental difference is that an ophthamologist is an MD. An optometrist does not have a medical degree. They do not perform surgery, prescribe meds, etc. They will often resort to alternative interventions that fall within the realm of their scope of practice. My husband is an ophthalmologist. He does not support the use of vision therapy, nor do any of the other ophthalmologists in our town. Very few optometrists support it here either. There is one guy in town doing it, and he's making a mint. He does not have a very good reputation among the other docs in the community.

My humble suggestion is that you could try it, but I woudn't do it in place of traditional intervention. It can't hurt, and you don't have anything to lose except for a lot of money. I doubt any insurance company will cover it because it's not been proven (scientifically) effective.

You may find that your ophthalmologists has more to offer than pencil push-ups.

    Bookmark   April 15, 2006 at 7:18AM
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So Sam_I_Am -- not trying to be argumentative -- I'm genuinely curious. How does an Opthamologist treat convergence insufficiency and visual tracking difficulties?

    Bookmark   April 15, 2006 at 2:28PM
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I would make the appointment for the pediatric opthamologist. I have been a patient for years. An optomotrist is not able to test my eyes for vision. I was born with a congenital defect and when it comes to your children's eye sight, go to the best.

    Bookmark   April 15, 2006 at 10:28PM
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Just a followup now that DD has completed her therapy.

She reports that the letters are no longer flying off the page. The optometrist reports that she can now converge at half the distance as before.

This required 10 therapy visits and almost daily home practice of less than 10 minutes per day to achieve, using the Rope Quoit, Beads, polarizing flippers, etc. Those of you who have gone through this will know what I am referring to.

Now we'll wait three months to see if the training has made itself permanent. I've required one hour of reading per day. Both of my kids have complied (for the most part) and DD hasn't complained of any eyestrain or vision difficulties, so I guess it worked! Thank goodness we got this out of the way during the summer.

Because of her commitment to practicing at home, we were able to finish therapy quickly, but there were many children with significant disabilities in the waiting room and I felt very fortunate her problem was not as severe.

I appreciate all of your encouragement to get this work done.n Thank you!


    Bookmark   August 3, 2006 at 7:25PM
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I'm so glad VT appears to have helped your daughter! There really isn't any better proof than our children's own reviews...

Seeing DS#1's mis-matched 'before' visiographs (which corresponded exactly to the types of reading errors he often made) was enough to convince me to try VT. Seeing his nicely-aligned 'after' visiographs, along with his own reports of easier reading, convinced me that it worked for him.

    Bookmark   August 3, 2006 at 10:31PM
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Near the end of third grade my DS's teacher expressed concern that DS was not able to copy material from the board. He also could not ride a two wheel bike or tie his shoe. At the eye doctor's office he was unable to copy a simple line drawing that most kindergarteners could complete. We started vision therapy and it changed his life. Because his eyes were not working together, he had trouble doing these simple things. I was both relieved and angry at myself that we hadn't discovered it earlier. By the end of that summer he had caught up to his peers. I will say he never did acheive grade level for some things. But he grew bored with the "homework". I still get the visiograph done at his eye exams. But I have to say without a doubt vision therapy worked for him.

    Bookmark   August 4, 2006 at 12:40AM
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VT supporter here, too. My DS2 was originally described as "too young" or potentially "ADD/ADHD" because he couldn't maintain focus. He was having similar convergence issues as those described above. After about a year of VT and wearing bifocals (that had no prescription), he had gotten much better at focising in on what on HIS paper, where his boundaries are, etc. Teacher agrees it has been a world of difference. He can also now better articulate when he is unclear as to what desk space is his.

    Bookmark   August 4, 2006 at 4:59AM
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No risk in seeing a pediatric opthalmologist...I don't know much about vision therapy...but, as the mother of a now 9 year old girl who had some developmental language issues, I think you are on the right track. All you can do is educate yourself, then make the best choices for your child. The money thing, while bothersome, shouldn't stop you. The bottom line is getting effective help for your child. Several years ago, people pish poshed sensory integration therapy...all these non drug, non surgical interventions such as speech therapy, occupational therapy, PT, nutritional therapy (I'm an RD), vision therapy, chiropractors, etc....there are many kinds of treatments that complement and support straight traditional medicine. I'm in the medical field (research), have been for years. What's important is that you do your homework, select a properly trained, lisenced professional, and give it a try if you think it will help your son. Do you have a medical spending account? That can help defray some of the costs. There is a lot individual medical practitioners don't know, or are not familiar with -- it's hard, but you need to search until you find someone who you think can help your child. Recently, my DH had a nerve problem in his neck that caused some of the muscles in his right arm and hand to atrophy -- it was kind of scary. I was kind of amazed that the "regular" neurologist and even the "specialist" neurologist couldn't diagnose the cuase specifically even with the mri and emg results, etc. In the end, we "picked" an experienced neurosurgeon who was able to fully interpret the mri within a few minutes and explain exactly what my DH's problem might be, operate, and now he is doing intensive PT and we hope his compressed nerves and muscle will regenrate. Once he showed us on the MRI, we could even see it ourselves! Drs and other medical personnel or therapists are just people offering you the best of their professional knowledge and opinions...the other thing I learned in my experience with speech therapy, OT, and now tutoring is that the right person can really help you child and that the experiences and recommendations of other parents who have been in your shoes are very valuable...advise from other parents, it's something you could potentially pay a professional thousands of dollars for. My advise is to put all the opinions together, decide what might work for your child and then get to work with some kind of intervention/therapy. If it's covered by insurance, grreat, if not -- then unless it's completely unaffordable, go for it.

    Bookmark   August 4, 2006 at 7:42AM
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Sorry to resurrect this old thread, but I thought I'd give some data to help evaluate the effectiveness of Vision Therapy in my (now) fifth grade child.

Her Terra Nova (standardized test) Reading score improved from 71st percentile to 97th in the year following the therapy and the Language section went from 86th to 98th! We are very pleased, and it turned out that almost 80% of the fees we paid were reimbursed by the medical insurance carrier.

FWIW, there was a letter to Dear Abby published in the Chicago Tribune on April 17, 2007 in which the writer describes her fifth grade daughter's problems prior to her diagnosis at the Mayo Clinic and the success she had with Vision Therapy. The condition was confirmed by Abby with her "experts" at the Mayo Clinic.

    Bookmark   May 25, 2007 at 11:04AM
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My son, Josh had vision therapy when he was 8. He is now 11. He is extremely bright, but couldn't tell the difference between right and left and kept mixing up d's and b's and other similar letter differences. At first I kept yelling at him (guilty feelings are coming back!) saying "you are too smart to keep mixing this up, you aren't concentrating!" and then all of a sudden I thought that maybe something was wrong. (a lightbulb) I thought that perhaps he was dyslexic. Anyway, after some testing, we found out that he had "tracking issues" (20/20 vision) and needed vision therapy. It really helped and he doesn't go for help anymore, although we have him retested whenever we go back to the eye dr. I remember the vision therapist telling us that for the rest of his life before a major exam (like SATs) or before the beginning of the school year that he should do the eye excercises for about a month. Parquetry pal blocks were great for this. I really believe in vision therapy and was very grateful for it.

    Bookmark   May 27, 2007 at 8:07PM
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I ran across this thread when searching for something unrelated... but it's a good topic, so I thought I would bring it forward again. I'd also had a really good experience with my son and vision therapy.

When my son was in Kindergarten, his teachers felt strongly that he needed to have testing done for "attention issues." After all the tests came back, there were many inconsistencies, and the psychologist drew the conclusion that he was ADHD. But luckily, she offhandedly remarked that some of the testing showed he could possibly benefit from vision therapy. Well, after researching the results on our own, I could see no clear evidence of ADHD, but after reading further, I though VT could help him. I had him tested with a specialist and she found some extreme focusing/convergence problems. After 2 8-week therapy sessions (1 hour per week) and daily 10-minute practice sessions, there was such a huge change in my son's reading abilities, focusing abilities... all aspects of his school work. I'd highly recommend it... especially if you have one of those children who you know is really bright, but something just seems off with how they're processing what they see or read.

Like Mary228's daughter, my son made lots of small errors in schoolwork and had trouble catching a ball, and like rivendell's son, mine mixed up the letters and right and left. Those were the kinds of clues that led me to believe there was something going on that was definitely not ADHD.

    Bookmark   December 7, 2007 at 12:47AM
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So here I am,1 1/2 yrs later coming across this post that I so badly needed to read. My 8 yr old daughter (jut turned 9) was seen nov 07' at the optomitrist,she had a thorough eye exam done and while her eye sight was 20/20 her vision was not. She has a tracking issue,like you all have said about your children. The treatment is VERY expensive that our insurance doesn't cover too. I wasn't sure what to think of her diagnosis so I put it on hold. Last week she had end of the school year reading and basically did very poorly and the reading tester lady marked down she has a problem with tracking,parent should have her tested. Horrible guilt set in and I now know what I need to do, VT. I do have some guilt that I should take her to an opth dr. instead and when I called,they recommended a dr. out of the city and that they don't support VT but would'nt tell me other than possible surgery what could be done w/out seeing her. So.. my options are to take her 3 hours away to a dr. who knows how many times for possible surgery,or pay the $1000 dollars for my daughters sake and have VT totally help her as it has done for so many other people. My daughter is very bright and very creative,yet complains when reading and doing math. I will try the VT this summer and see if she improves on her reading testing at the beginning of the 09' school year,if she does I will not seek help from an opth Dr.
An example in her tracking: She was given the word 'follow'
She read the f,her eyes skipped the o,she read the l,her eyes skipped the o,she read the w. So she read the 'flw' and in her brain she guessed 'flower'. When she can't read the words she makes up her own so that the sentence makes sense. Very Creative little brain,her poor eyes are just not helping her read. I will be back at the end of summer to update. Thank you guys for the testimonies and updates,I agree it's through your own experiences where us mom's get our data on what works and what doesn't.

    Bookmark   June 16, 2008 at 2:59PM
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Since finances come into play (don't they always!) -- be sure to mention that fact to your VT provider and ask that they give you exercises to do at home as well as in the therapy sessions. If you can get at-home practice and are serious and committed about doing it, you'll get results much more quickly, and will either finish sooner (and cheaper!) or just ship before wasting too much money if VT is not the answer.

Just FYI - Don't put too much faith in the 'follow' example, because MANY kids with reading problems would do exactly that. She saw three letters and guessed a word. The more reliable indication of a vision problem would be the reading tester's observations.

    Bookmark   June 16, 2008 at 3:41PM
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Kristy: I wish you luck with your child's reading issues. Sounds a lot like my daughter's problems. Even if we had to pay all of the fees, it would have been the best $1000 we could have spent.

Since another year has passed, I thought I'd give a followup with regard to the standardized test scores. Her reading has dropped from 97th to 89th percentile, still far above the 71st percentile prior to VT. I think her lack of pleasure reading has contributed to the decline. I'll have to enforce some reading rules this summer. I'm thinking, if she wants an hour on the computer, she has to read an hour. I'm the mean Mom, I know. Her language scores stayed a 98th percentile and her science and social studies remained in the high nineties.

    Bookmark   June 16, 2008 at 3:48PM
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I'm writing to give you a clear testimonial on how VT worked for my son. When I wrote in December, I had no quantitative data. I do now. When DS started second grade, he tested below grade level in reading using Scholastic Reading Index (SRI) computerized testing. He also would not be able to read 3 lines of large print text without his eyes watering and him saying his eyes hurt. This was part way through the first VT session. When he was tested earlier this spring, six months after the first test, and about 3 months after his VT work finished, his SRI score put him at a proficient 7th grade level! His teacher had him retake the test after a couple of weeks because she thought there was some type of error, but no, he tested even higher. She said that in 20 years of teaching, she had never seen such a huge improvement in reading score. He can now read books like Harry Potter... full pages with 10 pt type with no watery eyes, no headaches.

This summer, his VT specialist gave him some computer-based exercises to work on, which was a very inexpensive way to keep up with the therapy without weekly visits.

I definitely second what sweeby said about making sure your daughter keeps up with the at-home practices. Summer is definitely a good time to do the therapy when she's not burdened with homework, etc.

    Bookmark   June 16, 2008 at 5:36PM
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My daughter (just turned 15) went through VT this last spring and it was very effective. We are about to start school and I'm looking for a computer program to help her refresh. As much as she loved the therapy and its effects, she stressed out about having to miss so much school to go due to the driving distance to the doctor's office. Can you tell me what computer program/exercises your doctor recommended for your son? Any help will be greatly appreciated!

    Bookmark   August 13, 2008 at 12:36AM
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Our son is 25 and w/o a doubt VT is the best thing that ever happened to him. He's also very bright but was slow learning to read. After Kindergarten I took him to the "best" pediatric opthamologist in our L.A. suburb. He said his eyes were fine. After 1st grade the teacher asked me to have him checked again and he was in a pull-out program to help with reading. Again the opthamologist said he's fine, get a tutor. At the end of an awful second grade year the teacher said he's so inconsistent please have him tested for ADHD and learning disabilities. We did, at a well recomended educational psychologist.
Her report? He's probably ADHD (he is) and there may be other issues, but he's got a visual perceptual issue that's so bad she couldn't get a handle on it. She sent us off to a Developmental Optometrist who evaluated and said that the poor kid had basically double vision, couldn't converge on a line for more than the shortest time and he'd bet that the constant headaches and car sickness was related.
We began therapy and a fight w/ the insurance company. Remember this was 18 years ago and a very new concept. We won the fight but in the meantime after 6 weeks of twice a week therapy the car sickness disappeared, the headaches abated and things got better.
He did move into glasses first for magnification and then for nearsightedness correction. Therapy continued on for six months. But this man saved my kid.
And remember the "top" opthamologist told me it was bunk and to get a tutor. I've made sure to tell everyone what a jerk the MD was and act as an advocate for vision therapy. I'm not sorry! Good luck!

    Bookmark   August 18, 2008 at 4:31AM
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Opthamologists are not taught about vision training. It is dismissed in their training. Their emphasis in school is much more on surgery. But it can and does work for a lot of children.

    Bookmark   August 19, 2008 at 10:01PM
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Sorry I didn't see your post until now, I've been away on vacation. The software is called HTS iNet Computerized Home Therapy System.

If your daughter keeps up with the 10-15 minutes/day exercises that she learned with the therapy, I think that is just as good. I've had trouble keeping DS (and myself) motivated to do the computer exercises regularly. It seems easier to do the physical exercises.

    Bookmark   September 2, 2008 at 11:07AM
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