Vision Therapy: Expensive and Useless?

Warning: If you are considering vision therapy, think very hard first. Jump straight to the links at the bottom of this post, particularly the position paper on vision therapy by the American Academy of Ophthalmology.

For what it's worth, here's my take, and my experience.

It doesn't seem that eye exercises and vision therapy programs will hurt you, or your child, or whoever. But they will hurt your pocketbook, and that severely. There is a very long history of snake-oil sales associated with vision therapy. The value of its current incarnation--called orthoptics--is questionable at best, except in very specific situations. The link between vision exercises and reading difficulties is more than tenuous. All the studies are second- or third-rate (again, see the white papers linked below), and as one ophthalmologist said to me, "It's not likely that any level-one studies are going to be done, unless it's by ophthalmologists, because it's in the optometrists' financial interest that they not be done."

My daughters did a course of vision therapy, which cost them hundreds of hours and my ex-wife and I well north of $5,000. It was recommended by Nancy Torgerson, an optometrist, and administered by her clinic, Alderwood Vision Therapy in Lynnwood, Washington.

This is an extremely condensed version of a long and expensive tale.

My kids had been to multiple eye doctors with no concerns (except that one is nearsighted and wears glasses) before my ex found Alderwood. My ex has had ongoing anxieties that the kids have some kinds of learning disabilities or reading "challenges." (They're both thriving at a challenging private school--As and Bs, lots of friends and activities, no concerns by any of their teachers, coaches, etc.) Since we'd already spent a lot on vision evaluation, I resisted doing more, especially by an outfit that makes its money from vision therapy. My youngest was in fifth grade, and felt like she wasn't reading as fast as her friends. My ex took her for a checkout. Surprise, they said that she needed a course of therapy that they would administer. Daily computer exercises [they sold us the software], plus weekly "therapy" sessions at $90 a pop.

The multipage written report from Ms. Torgerson--which is mostly boilerplate (I know because we've received several of them)--justifies the necessity by saying that it will provide for "optimum academic accomplishment." The mealy-mouthed recommendation is predictable given the weak science that underlies it. There would be liability issues if they were to state that the therapy is "medically necessary." My ex tried to get Ms. Torgerson to say that, in writing, but she would only say that it's "visually necessary." Draw your own conclusions about what that means. My youngest feels like she reads better now. Whether that is attributable to eye exercises is questionable, given what the authoritative studies say. Kids's abilities in various areas change a lot, and rapidly, at that age.

As things went along Ms. Torgerson also recommended therapy for my oldest daughter, who didn't feel she had any particular reading challenges. Ms. Torgerson made that "diagnosis" and recommendation without ever meeting my daughter, or even talking to her.

One of the key questions I asked Ms. Torgerson at one point was about the "norms" that she said the girls were working towards:

•    Where do those norms come from?
•    What percent of the population (or the adolescent population) meets those norms?

In other words, should 10% of people be receiving vision therapy? 60%? 98%? Where do my kids fall in the spectrum? Bottom decile? Top decile?

She couldn't answer. My daughter asked her the same thing. Same (non-) answer.

At that same meeting my daughter asked what long-term effects could result from not getting vision therapy. I was quite surprised when she reported that Ms. Torgerson said there was a danger of retinal tears. (That's rips, not drops of water.) So I sent her an email:

Jesse tells me that during her recent meeting with you, you said that without eye therapy, retinal damage could result. Naturally, this surprised and concerned me, as it's something we haven't heard in the past.

Could you give me details on that, or if necessary explain what Jesse may have misunderstood?

She replied:

She was asking what are some of the problems that could happen with high nearsighted.  She wondered why it would ever be a problem.  If a person could just wear glasses then it didn't seem so bad.  I told her that the frequency of retinal tears increases with the incidence of high myopia.

I replied:

Thanks for the explanation. I thought she was probably misunderstanding. This issue is unrelated to eye exercises, correct?

She never replied. This is not surprising--eye exercises as a treatment for myopia were resoundingly debunked decades ago. No responsible optical professional would dream of suggesting such a linkage.

I eventually got fed up with being taken for a ride, and took the girls for an evaluation by a pediatric ophthalmologist on the faculty of a major university medical school (ophthalmologists are M.D.s--real doctors) with a specialty in orthoptics. Not surprisingly, he determined that there was no reason for the girls to be doing eye exercises (which can have some efficacy in some particular cases), and even less for them to be taken out of school once a week for expensive in-office therapy sessions (which have virtually no scientific justification, but far higher revenues and profits for the clinic).

This posting could be far longer. But I and my daughters have already spent way too much of our lives dealing with this stuff. So I'll stop recounting our story and give my advice:

Be very, very skeptical about any diagnoses or recommendations from outfits that make money providing vision therapy.

Here are two links that you won't find on the web sites of vision-therapy practitioners:

• The American Academy of Ophthalmology's policy statement on Learning Disabilities, Dyslexia, and Vision.

Key quote:

"No scientific evidence exists for the efficacy of eye exercises ("vision therapy") or the use of special tinted lenses in the remediation of these complex pediatric neurological conditions."

• Another white paper on vision therapy from The Institute for Clinical Systems Improvement. ("ICSI, a collaboration of health care organizations, is an objective voice dedicated to championing health care quality and to helping its members identify and accelerate the implementation of best clinical practices for their patients.")

I sure wish I'd found these sooner.

Here's more commentary from a blogger who covers parenting and learning disabilities. And here is a writeup from quackwatch.org (written by an O.D., a Ph.D., and an M.D.) that lays out the issue very cogently.

 

Comments

[Drew]

Steve (I think)... What a wonderful expose! I am the middle of experiencing the nearly the exact same situation. My ex has recently taken me back to court to get more money specifically for vision therapy for my 4th grader. I visited the OD last week(I better not say his name or the name of his Garland Texas office because he's already shown he's sue happy) and confronted him with my doubts. This man told me that not only could my son's 'reading problem' be solved with vision therapy, but the reason that my ex doesn't see the improvement after CLOSE TO A YEAR of therapy off and on, is because they were doing the exercises wrong. UGH. This guy also told me that he has CURED a patient of Tourette's syndrome! And.. one more.. he told me that the pediatric opthamologist that saw and diagnosed my son as having A+ visual accuity was dead wrong and that he was going to sue him!

I am soooo glad to see your post. It gives me hope... and the position papers you've posted are going to go over well in court... I think that's where it'll end up.

Please e-mail me. I'd like to discuss this more if you have time. Thanks

[B. Fong]

My son, age 7 1/2 has recently been "diagnosed" by a local optometrist. I became suspicious when the doctor said three times, " I can't believe the other doctors missed this." Doctors don't say things about other doctors and he was very careful not to pinpoint anyone or slander them, but make it out like he was the one who was going to solve all of my son's problems. My son was born with congenital ptsosis. He has had many surgeries to lift his eyelid up and it has affected his vision. We have seen many specialists. I then became suspicious when I asked an employee of the doctor's office why my insurance company doesn't pay for vision therapy. They always replied that they didn't know why..."call your insurance company." Well, now I know why. What I'm most upset about is how many times they lied to me. Why not just tell me up front? Now that I clearly don't trust them, I'm thankful I got this information sooner than later. They won't be taking me for a ride!!

[Steve]

Hey Drew:

I'm glad you found the post useful. Hope it saves you and your kids some time and money. I just re-visited the third link provided, by the way, and am stunned by what a good job that blogger did--even more solid white papers from authoritative sources, great analysis and discussion.

http://lizditz.typepad.com/i_speak_of_dreams/2004/10/reporter_is_clu.html

Thanks,

Steve

[Drew]

Steve - Yes, I enjoyed Liz's blog as well. I have traded several e-mails with her and we seem to be of the same mindset. I'm now in the process of getting rolling with information from Dr Mel Levine (www.allkindsofminds.org) and some of his techniques...lots of great material there for those who have a hard time staying focused and 'on task', yet definitely don't fall into the ADD category.

Thanks.

Drew