Mar 27, 2008

THE EYE MAN: Effectiveness, cost of vision therapy varies

Dr. Andrew Soss / Daily News columnist

Dr. Soss: I want to follow up on some of your comments regarding children who need patching and, as you called it, using "visual work tasks." Is this what they call vision therapy? I had my child go through this for about a year. It costs a lot of money and takes a lot of time. We did not see the end result being much different than where we started. I will admit that there was some change, but not enough to warrant the time and the cost associated with this. Our insurance company also did not pay for any of this. Is there any other procedure that is either covered by insurance or is less time-consuming or less costly than this?

L.R.



L.R.: Vision therapy is the term used for a series of related exercises meant to stimulate the visual system by correcting its maladaptation while enhancing proper binocular development. Most eye doctors provide limited vision therapy. There are vision development specialists who do in fact provide a comprehensive treatment program. Unfortunately, as you point out, insurance carriers rarely cover the expenses related to this treatment.

Part of the problem, as I see it, is that each of these practitioners has somewhat their own take on how best to treat these various types of visual abnormalities. There appears to be less standardization amongst how to approach patients with vision development issues, versus conditions such as glaucoma. As a result, insurance carriers do not see the cost /benefit relationship to provide funding for such services. The reality is, there can be several effective approaches to achieving the same outcome.

The other point that you brought up has to do with the effectiveness of the treatment altogether. As with any other disorder, typically the earlier the intervention, the more effective and better the prognosis. What is different between vision therapy treatment programs and other medically treated conditions, such as glaucoma, is that vision therapy requires a much greater commitment of time.

For example, when I am treating the vast majority of my patients with glaucoma, it requires them to do nothing more than show up to my office once, twice or as much as three times a year for me to evaluate their condition. The most common form of treatment simply involves the patient placing eyedrops in their eyes (in most patients, only one time per day). On the other hand, a patient who requires vision therapy may have to go to the eye doctor's office several times a week for months. Additionally, there may be - and usually is - an assignment for home activities, which also demand a great deal of time.

If the end justifies the means, it is clearly worth the effort. Insofar as insurance coverage is concerned, you as a consumer can talk or write to your legislators explaining to them your frustrations. Only then can a change be made.

All answers and opinions are those of Dr. Soss and are not necessarily shared, endorsed or affiliated with this newspaper.

Dr. Andrew C. Soss has been practicing for more than 20 years. During that time, he has been a clinical instructor in the deptartment of ocular pathology at the University of California. As a primary eye care provider in private practice in Burlingame, he is also board certified in the diagnosis, treatment and management of primary open-angle glaucoma.