More Thoughts From the Well-Trained Minds

It is often insightful to read real-life discussions between moms on the Internet, and The Well-Trained Minds is a forum that I’ve cited before that is excellent in this regard.  This thread is about payment for vision therapy, and there are several highlights worth noting:

1) “I called every single COVD dr in Charlotte and went with Dr Farham at Summit in Gastonia. Much much much cheaper. I felt like many of the dr’s were JUST in it to make money. Very disappointing!”

Well, that’s one parents’ point of view, but where do you think the impression comes from that many of the doctors were just in it to make money?

2) “We are doing the at home program which many other places do not offer but there in office prices are even much cheaper. $75 vs $135 for a session and the evaluation is half the price too. There is another place in Gastonia on the covd website that was much cheaper than the other places too!

There will always be price shoppers determined to find the least expensive way to do something.  Until proven otherwise, the CITT essentially established that home alone programs are equivalent to results through placebo therapy.  You really do get what you pay for.  That’s alot different than saying that all VT-ODs think about is money.  It’s a way of saying that there’s a certain cost of doing business, and as much as we’d all like to be magnanimous and give our services away, the IRS still considers us a business.  By the way, if you think economies of scale aren’t weighing heavily on medical practice, even stem cell cord banking has resorted to coupons!

3) “See if this doctor accepts CareCredit. They have no interest for 24 months right now if you make your minimum payment each month. This is how we are paying for our VT.

CareCredit remains a great option to assist patients in being able to undertake vision therapy.

4) “Don’t forget about Gap Exceptions. In our area (I’m in Charlotte also) none of the Developmental Optometrists take insurance. This means that they are considered “out of network” with the insurance company. I called my insurance company and got a ‘gap exception’ approval. Since there are no “in network” vision therapist providers in a certain radius of my zip code with the gap exception all of my vision therapy appts are covered as “in network”.

At the opening night session of this year’s COVD meeting we discussed the pros and cons of being a par provider for insurance companies.  My position has been to remain largely outside the system, and many specialists are increasingly practicing this way.   I understand the rationale of those who perceive that they need to remain inside the system, but for those willing to break out of the shackles of third party care – the idea of gap exceptions, as noted above benefits both providers and patients.

5) “Are they getting bifocals or something? My dd was 20/20 but they gave her reading glasses. The glasses aggravated the focusing and convergence problems so we went from troubles with school to being able to do NO school. Worst $200 I ever spent. But I understand sometimes they aren’t 20/20 or need bifocals or something different. But just to try reading glasses to get away without VT, well that was a huge waste for us.

And yes, I would scrimp on food, sell the dog, do anything to get VT. It’s THAT life-changing. Return Christmas presents, cancel cable and cell phones, yes, I would do those things to get VT. Maybe you’ll have a tax return coming in April to get one of them going?”

Wow.  Let’s address the glasses first.  Way back in 1985, I presented a paper at the American Academy of Optometry reviewing research from Pierce and Greenspan using Galvanic Skin Responses to show that in some instances a plus lens prescription at near has deleterious rather than beneficial effects.  I believe that is why the old OEP masters used to talk about the judicious application of lenses.  I still don’t get why some of our colleagues feel that it’s a virtue to push plus and/or yoked prisms on everyone, but that’ll be a subject for another day.  This is not to imply that the opposite extreme is judicious.  It’s just as egregious when practitioners withhold a lens prescription because a patient can see 20/20 without it.

The issue here, as this mom relates forcefully, is that it was a mistake in her child’s case to think that a lens prescription could be a cheap alternative to office-based vision therapy.  What she concluded is so heartfelt, and so powerful, that I want to repeat it again:

“And yes, I would scrimp on food, sell the dog, do anything to get VT. It’s THAT life-changing. Return Christmas presents, cancel cable and cell phones, yes, I would do those things to get VT. “

– Leonard J. Press, O.D., FCOVD, FAAO

4 thoughts on “More Thoughts From the Well-Trained Minds

  1. As a parent who has taken part in such online discussions with other parents, this post really caught my eye! My daughter Stella, as you probably know since you’ve seen our blog, using yoked prism goggles. While I feel great about it and have seen them yield benefit for her, I have a hard time explaining them in satisfactory fashion when asked about them by other parents. I wonder how they are being overused and how parents can judge whether their use is called for or not? I have noticed that they no longer seem to affect my daughter’s toe-walking, so starting to re-evaluate.

    Another thing I’ve noted about parents’ online comments as they consider (or sadly, often reject or express “suspicion” about) vision therapy is that they will only trust research not funded by optometry departments and optometrists and the like. But don’t ophthalmology depts and ophthalmologists do the research pertinent to their field as well. Honestly, it’s so frustrating that I don’t even bother replying. They’re not going to open up to it until their ophthalmologists and healthcare providers do. Maybe parents like the impassioned one you quoted above will help bring about that change.

  2. Thanks for sharing your thoughts, Amber. First of all, Stella’s developmental optometrist, Dr. T. is more authoritative on yoked prism than any pediatric ophthalmologist. The simple fact is that they know nothing about it, and have never prescribed it, yet they’re quick to dismiss it out of hand. If you’re trying to explain it to others, here are a couple of nice sources, one more detailed and the other very concise:

    Someone like Dr. T does not overuse the prism Rx, and I would trust her judgment on when they’re indicated, and when they need to be changed or are no longer indicated. There’s a simple way to decide if someone is overusing yoked prism Rxs: What percentage of all patients consulting that doctor receives yoked prism? If the answer is 100%, there’s something wrong. As wrong as someone who pretends to be an authority on all things visual, and would never consider Rx-ing them.

    You are absolutely correct — it is intellectually dishonest, verging on the unethical, to pretend that research done by Optometry can be discounted because it is somehow biased, yet research done by Ophthalmology is pure and unbiased. How silly.

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