By Morvari Ahi, OD
Nov. 23, 2016
VT Supplies & Tools: Small Investment, Big Results
The tremendous difference vision therapy can make in the lives of patients often comes a small cost to the practice in needed supplies and tools.
For example, a Marsden Ball, like this, can be purchased for under $50.
Source: Bernell (Marsden Ball)
Patients can benefit from tools like the Marsden Ball (above) and from easy-to-access online platforms that aid the vision therapy process, such Eyecarrot’s Binovi Pro Platform (below):
Source: Eyecarrot (Upcoming Binovi Pro Platform)
Vision Therapy Billing Resources
Three articles effectively explain vision therapy and insurance:
—Morvari Ahi, OD
Prime Your Practice for Growth
As a new practice, we are currently growing our vision therapy center, offering it as a specialty service to our patients, along with low vision and specialty contact lenses.
We often spend at least 12-24 weeks with a family and grow very close to them. As that bond and trust grows, it leads to referrals for family members and friends.
Offer Flexibility in Office Visits to Patients
As a new practice, I work hard to be flexible for my patients. Currently, many of my patients are on a computer vision therapy program that I monitor every 2-3 days. I am able to access the patient activities and modify/personalize them according to the diagnosis and progress of each child. Most of my vision therapy patients visit me in the office every week or every other week for in-office therapy for 30-60 minutes.
My staff and I work hard to make vision therapy affordable for every family. Initially, we discuss the diagnosis with their insurance company to see if there is any coverage for therapy. If we are unable to have insurance cover the therapy, I sit down privately with the parents and discuss the financial commitment involved. Some prefer to pay the amount upfront, while others prefer installments.
I reserve every other Saturday and one afternoon every week for my vision therapy patients. By having vision therapy reserved for one afternoon, I am able to set up my vision therapy equipment before my patients arrive. We try to pre-appoint our patients, so the parents have a set schedule for their therapy. We request that they provide us notice of any schedule changes at least two weeks in advance so we can schedule another child or appointment in that time slot. In the future, when we have a separate room dedicated to vision therapy, I look forward to having vision therapy offered every afternoon after school.
Gauge Needed Investment
The expenses for adding vision therapy to your practice can greatly vary and depends on your budget. Many vision therapy tools are inexpensive and can even be made at home (ex: Brock String). There are more advanced tools (ex: Sanet Vision Integrator) that can be $5,000+.
Many of the costs for vision therapy are upfront. The equipment is usually durable and can be reused for multiple patients (e.g., Hart Chart, Marsden Ball). The field of vision therapy is constantly growing and expanding. Eyecarrot and Senaptec are two examples of companies that are contributing to the advancement of vision therapy.
Project Needed Doctor Time
The amount of chair time a vision therapy patient requires can vary greatly depending on their diagnosis, progress and the schedule of the family. I have had some optometrists refer their patients to my office for a binocular vision evaluation. In these cases, the comprehensive eye exam has already been completed. Depending on the age and diagnosis of the child, my initial evaluations are usually 45-90 minutes long.
We offer in-office therapy which lasts 45-60 minutes, every week or every other week, so we schedule one per hour. Weekly sessions that range from 45-60 minutes are common in vision therapy practices. In addition, I offer evaluations at the mid-point of therapy and after their final session. These evaluations usually last 45-60 minutes. Most of the time commitment for vision therapy is preparation. I prepare reports after each evaluation that I share with the parent, and their teachers if the parent requests. Also, I prepare each activity for their in-office sessions, as well as review their computer activities every 2-3 days.
For a 45-60 minute session, I reserve time at the beginning/end of each session (5-10 minutes) to discuss the past week with the child and how their at-home exercises are going. I also review the child’s progress and goals for the week with the parent at the end of each session. We usually complete 3-5 activities during the 45-60 minute session depending on the age/progress of the child.
During each session, I am also taking copious notes. Each of my activities have difficulty levels. If an activity is too difficult, we take it a step back and make it easier before moving forward. My notes help guide me for the following session to make sure we are gradually building the child’s confidence through each activity, but also making it challenging for them as they progress.
Vision Therapy: Do I Have the Know-How?
As an optometry student, I took advantage of every CE lecture and presentation on pediatrics and vision therapy.
I also was co-president of the College of Optometrists in Vision Development (COVD) during my third year of optometry school, which helped me learn more about the organization and invite lecturers to my optometry school to also educate other students interested in vision therapy.
If you are in optometry school, I would encourage you to complete a pediatric or vision therapy residency. If you have already graduated, there are still many educational opportunities available to you.
I would encourage you to join COVD and OEPF and attend local upcoming meetings/conferences. Both organizations have numerous opportunities throughout the year. Other organizations that provide training include Lecoq practice development, Toni Bristol, and Tom Headline.
—Morvari Ahi, OD
My average vision therapy patient is 8 years old. However, I have worked with patients as young as 2 years old up to 50+ years old.
The research on vision therapy is compelling. However, it can be difficult to quantify a binocular vision disorder to parents. It is not the same as a broken bone that is visible. It is important to explain to the parent how complicated the visual system is and how there can sometimes be missing links within that system. My goal as an optometrist is to strengthen those links so the child achieves his or her personal goals.
If a parent is concerned about the investment, we discuss those concerns. In the past, I have let some patients start with only five sessions so the parent has the ability to see some initial progress. I understand that they want to see firsthand some results before committing a large amount of money to the therapy. I believe keeping an open dialogue with the parents is beneficial so they feel comfortable telling the provider that their child is not completing the exercises or they aren’t seeing progress. Providing the parent a detailed account of the diagnosis and realistic expectations for their child’s progress is also helpful.
Incentivize to Stick to Regimen
Many of my patients use our computer vision therapy program combined with in-office therapy. I have found the highest success rate with this combination of therapy. If a child can work on the computer or iPad, they are usually more enthusiastic about the activity.
We provide each patient a sticker chart and allow them to choose a gift card at their first visit which we write on the top of the sticker chart. Most of the my patients complete therapy five nights/week for at least 20 minutes. Parents are encouraged to provide a sticker to the child if they complete this minimum. More stickers means a larger gift card. This has worked for the majority of my patients. The gift card locations include Target, Toys’R Us and other stores.
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