The advent of health care consumerism is a double-edged sword. On the one hand patients have been empowered to find positive information about vision therapy. On the other hand they may generalize their child’s case from information on the Internet, when in reality their case may be more complex.
The CITT is well-known to most of you. My colleague Dr. Fortenbacher and I have blogged about it numerous times. The basic conclusion of the CITT was that office based therapy combined with assigned home activities had significantly better outcomes than home therapy alone, pencil push-ups, or placebo therapy. The office based therapy was designed to be completed over a 12 week period, and very detailed logs were kept of home therapy procedures. The success rate of vision therapy over this period of time was 73%. Let me be very clear about this: the 73% rate was significantly better than other forms of treatment in the study, and the CITT itself was a monumental achievement. But its intent was never to encourage parents to select vision therapy a la carte, or to imply that longer periods of therapy were not beneficial and in some cases essential.
Nevertheless, some parents will visit sites such as the Mayo Clinic, and conclude that 12 weeks of vision therapy is typically all that’s needed. Or, if they can’t afford vision therapy, they may just opt for an inexpensive approach no more effective than a placebo. Even when considering vision therapy they may reason: “Well, if my child has been diagnosed with CI, and the doctor prescribed something more than 12 weeks, that’s probably because he wants to increase the chances of success to something above 73%. But a 73% success rate is fine with me”. Or, as another parent recently told our patient care coordinator, “I would rather do three months of therapy, and then if the doctor feels more is needed we can consider doing more.” And the latest trend, parents asking that we forego progress evaluations because they’re only interested in the final outcome.
Here’s the bottom line: vision therapy is not a commodity. The doctor prescribing vision therapy takes into consideration the differential diagnosis, the complexity of the condition, the nature of the patient’s co-morbidities, and formulates a treatment plan. Would a parent think of negotiating with any other professional at the outset regarding how much therapy is appropriate for their child? In any doctor-therapist-patient relationship there must be some good faith involved in the professional’s expertise. Having said that, it is customary in our practices to give the patient a projection of how much time is involved in therapy, and how many evaluations will be conducted. The intent of a patient care contract is to inform, not to bind. Patients are not coerced into undertaking vision therapy, and if a patient is unable to complete the number of sessions projected they are not obligated to continue. All this adds up to a therapy program positioned to help the child succeed; to make changes along the way based on the child’s progress; and to safeguard against regression after office based sessions have been completed.