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In recent days this question has come up quite a bit in our office. Most often when families and individuals begin noticing positive changes, they are almost upset that they were not aware of this type of intervention sooner. I struggle to give an adequate answer. Many individuals and families have endured quite a lot and ask this question as though they want to know who or what is responsible for keeping vision therapy out of the public eye. Here are a few of the reasons:
On the east and west coasts, vision therapy is more common. In California there are 82 developmental optometrists who are board certified to diagnose and treat vision disorders with vision therapy. In Florida there are 29 and in New York there are 41. In Indiana, I am one of 6 practicing optometrists who are board certified. There are 7 in Kentucky and 10 in Ohio. One might think there are more board certified doctors where the population is greater however the Schools of Optometry located in those states also happen to be very well known for their Binocular Vision and Vision Therapy curriculums and residency programs. While the School of Optometry in Indiana is a very good school, it is not known for it’s Binocular Vision and Vision Therapy programs. I am very proud to be an alumnus of IU and of the IU School of Optometry. In my opinion, Bloomington, Indiana is the best place on earth. However, after graduation I knew that if I wanted to specialize in vision therapy further education was going to be required.
There was a time in the 1980’s it was theorized that vision therapy could be a treatment for dyslexia. In the late 1980’s this theory was found to be wrong. Optometric articles published in 1985 and 1988 state that vision therapy does not directly treat dyslexia or learning disability. This point was reiterated in a 1997 report approved by three national optometric organizations. However, the medical community at large refuses to let developmental optometry live it down. In a very recent 2011 report headed by the American Academy of Pediatrics, the point that vision therapy does not treat dyslexia or learning disorder was mentioned 61 times in its 41 pages. There has not been such a claim made within the developmental optometry community in more than 30 years.
3. Half truths
While harping on the point mentioned above, the medical community does acknowledge that vision therapy allows for easier, more comfortable reading by treating vision disorders. That reading and concentration may occur for longer periods of time by treating vision disorders. These statements are made in the 2011 report mentioned above. There is just as much published scientific support for the effectiveness of vision therapy as there is for other forms of therapy such as physical and occupational. To say there is little evidence in support of vision therapy is to deliberately ignore its intended purpose of treating visual disorders not dyslexia or learning disability.
None of these reasons are acceptable to me as answers to the original question of why vision therapy isn’t more common. Never the less they are beyond my control. However, my team and I can control the level of service we provide to the families of our local community and beyond. The success of vision therapy at our office has not gone unnoticed by some area physicians. We value their partnership and continue to expand our referral network. We at Vision Development Center make it our business to provide our community with the same specialized care found 1,000 miles away. We deserve it here too.
Contact our insurance liaison at Vision Development Center for assistance in determining your medical insurance coverage for our services. As a courtesy, we will file claims for the initial evaluation and if indicated the first vision therapy visit only. We are experienced in providing you with the documentation necessary for you to submit to your medical insurance provider for any further treatment. We do not have a contract with your insurance company, only you do. We are not responsible for how your insurance company handles its claims or for what benefits they pay on a claim. We can only assist you in estimating your portion of the cost of treatment. We at no time guarantee what your insurance will or will not do with each claim. We also can not be responsible for any errors in filing your insurance. Once again, we file claims as a courtesy to you. We will answer any questions you may have regarding any documentation we have provided. Many current insurance plans are designed to cover most of the basic vision-related costs, but not all costs associated with vision care.
Fact 1 - NO INSURANCE PAYS 100% OF ALL PRODEDURES
Medical insurance is meant to be an aid in receiving medical care. Many patients think that their insurance pays 90%-100% of all medical fees. This is not true! Most plans only pay between 50%-80% of the average total fee. Some pay more, some pay less. The percentage paid is usually determined by how much you or your employer has paid for coverage, or the type of contract your employer has set up with the insurance company.
Fact 2 - BENEFITS ARE NOT DETERMINED BY OUR OFFICE
You may have noticed that sometimes your medical insurer reimburses you or the doctor at a lower rate than the doctor's actual fee. Frequently, insurance companies state that the reimbursement was reduced because your doctor's fee has exceeded the usual, customary, or reasonable fee (“UCR”) used by the company. A statement such as this gives the impression that any fee greater than the amount paid by the insurance company is unreasonable, or well above what most doctors in the area charge for a certain service. This can be very misleading and simply is not accurate.
Insurance companies set their own schedules, and each company uses a different set of fees they consider allowable. These allowable fees may vary widely, because each company collects fee information from claims it processes. The insurance company then takes this data and arbitrarily chooses a level they call the “allowable” UCR Fee. Frequently, this data can be three to five years old and these “allowable” fees are set by the insurance company so they can make a net 20%-30% profit.
Unfortunately, insurance companies imply that your doctor is “overcharging”, rather than say that they are “underpaying”, or that their benefits are low. In general, the less expensive insurance policy will use a lower usual, customary, or reasonable (UCR) figure.
MOST IMPORTANTLY, please keep us informed of any insurance changes such as policy name, insurance company address, or a change of employment.
It has been our experience that providers of medical insurance vary widely on the procedure of filing claims for vision therapy services as well as the documentation that is required for each claim. The international association of developmental optometry known as the College of Optometrists in Vision Development have on record less than 1,500 affiliates practicing this specialty worldwide. Due to the small number of providers offering this service, the protocol for claim submission is not consistent within the insurance industry.
At Vision Development Center, our intention is to provide an excellence in care. This includes doing all we can to make our services attainable.
Minds in Motion, which is implemented in many of our area’s school systems, is a great program for children to stimulate and challenge the brain through movement. However, children who are not able to do the activities correctly do not benefit from them. This is especially true for the eye teaming portions of the program. Incorrectly repeating the same activity over and over doesn’t teach the brain how to team the eyes better. These children need specific instruction by a trained optometric professional on how to control eye movements as well as maintain their eye teamwork throughout the demands of a school day. Teaching the brain to efficiently use both eyes together is what we do best.
Vision screenings will typically only check distance visual acuity. This of course is important, but many visual issues can be missed in these screenings. A binocular vision evaluation fully tests how the eyes work as a team and with the brain. This type of testing goes beyond what is done in a routine eye exam which focuses primarily on eye health and the need for contacts or glasses. We test all visual skills, including eye teaming, eye focusing, and visual information processing. Uncovering problems with how the brain commands the eyes to work together and how the brain uses visual information require specialized testing by a board certified developmental optometrist.
The post-doctorate residency program is typically one year in duration to complete certification. A doctor of optometry in residency spends a minimum of 50 hours a week obtaining additional training, knowledge and expertise in the specialized fields of optometry. Residency programs with emphasis in Binocular Vision and Vision Therapy entail extensive clinical experience in optometric vision therapy and pediatric eye care, including infants and children with special needs. The programs also require active involvement in research, lectures and teaching. Individuals who successfully achieve Residency Certification serve as experts and leaders in the specialized fields within optometry. Doctors of Optometry are not required to fulfill a residency program prior to practicing their profession; a key factor in the very limited number of optometrists nationwide achieving a Residency Certification.
Fellow of COVD
The College of Optometrists in Vision Development (COVD) is a non-profit, international membership association of eye care professionals. Established in 1971, COVD provides board certification for eye care providers who are prepared to offer state-of-the-art services in behavioral and developmental vision care, optometric vision therapy and vision rehabilitation. The COVD International Examination and Certification Board process includes a rigorous evaluation of the eye care professional's knowledge and abilities in providing developmental and behavioral vision care for patients. Optometrists who successfully complete their certification process are Board Certified and are designated Fellows of COVD (College of Optometrists in Vision Development). This process involves a Certification Board review and acceptance of written essays on diagnosis and treatment of various areas of visual function and written case reports including the basis and rationale of treatment. Documentation meeting specific criteria of experience of the optometrist in vision development and vision therapy is submitted and verified. Upon successful completion of the written portion and documentation, optometric candidates are then eligible to take the exam and sit for the final oral interview to take place at an annual meeting with members of the Certification Board. As of April 2015, there are only 7 practicing optometrists in the state of Indiana who hold the distinction of FCOVD.
Dyslexia type symptoms can occur when there are eye teaming, eye tracking and perceptual problems that can cause words, letters and numbers to appear to move or jump on a page. Many people mistakenly think that they or their children have dyslexia because they can see 20/20 with or without corrective lenses and still have trouble reversing words, letters and numbers. Many of these same children and adults have never been tested for dyslexia or told that they may have a vision disorder. There are cases where both problems are present. True dyslexia can still be present in rare cases after vision disorders are resolved, but in many cases what was thought of as dyslexic symptoms disappear once the eye teaming, tracking and perceptual vision skills are strengthened.
Undiagnosed vision problems can often be confused ADD or ADHD. Attention span, restlessness and frustration in the classroom and out of the classroom can result from not being able to process the millions of pieces of visual information needed to learn and function in tasks that are needed everyday. There are many symptoms that visual disorders, ADD and ADHD have in common. Please make note of the symptom checklist provided on this website. There are several symptoms that are unique to ADD and ADHD such as running and climbing excessively, difficulty in playing quietly and always being "on the go". When the problem is a visual disorder, there are many instances where parents hear of symptomatic behaviors in the classroom and are baffled as to why they do not observe those same behaviors in the home where visual tasks are less demanding.
Within the medical community there are misunderstandings and miscommunications concerning vision therapy. At the center is a common misconception that vision therapy is a treatment for dyslexia and learning disability. It is not. Vision therapy relieves the burden of a weak visual system and can allow reading and concentration to occur more comfortably for longer periods of time.
Open Letter: Dr. Bauernfiend has spent countless hours reading through medical publications in an effort to shed some light on the views of the medical community and where that information is sourced. The recommendations made in a recent Joint Statement and subsequent Joint Technical Report published by the American Academy of Pediatrics is in short incomplete. Please include Dr. Bauernfiend's review in addition to other information available to make a fully informed choice for your family, student or patient.
The College of Optometrists in Vision Development also maintains an archive of published research articles and clinical studies on the effectiveness of vision therapy. In addition, thousands of patients each year who experience the benefits of vision therapy can attest to its positive impact on their lives.
In 2008, the National Institute of Health published a study in the Archives of Opthalmology which demonstrated that in-office vision therapy is the most effective treatment for convergence insufficiency a vision problem which impacts children and adults.
When the program is complete, the benefits of vision therapy will last for a lifetime. Accurate focusing and efficient use of both eyes together is a reflex which, when conditioned, should operate effortlessly. Vision therapy, as related to visual perception, prepares children for lifelong learning, and it fills in gaps for many adults who have lost visual skills and abilities.
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