In my fourth year of optometry school, I interned at a vision therapy (VT) office one day per week. I had learned about vision therapy in school: using aperture rules, doing the 21-point exam, and testing visual information processing.
However, during the internship, I witnessed individuals’ lives being transformed through improved awareness and control of their visual systems. I realized that vision therapy was not only affecting patients’ eyes; it affected behavior, confidence, and coordination. Eight years later, I joined an established private practice and added VT as a specialty.
Insight Vision Therapy
Everything you need to add vision therapy to your practice
Vision therapy is a unique specialty in that it usually involves weekly appointments with patients to optimize their visual function. While orthoptics works on movement and coordination of the eyes, VT works on the interaction between the eyes, brain, and body. There were several factors that made my VT dream a reality.
A solid education
Upon graduating, I attended the annual College of Optometrists in Vision Development (COVD) meeting and took an Applied Concepts course by Dr. Bob Sanet. The following year, I attended Dr. Sanet’s five-part vision therapy course in San Diego. This gave me a firm foundation in the diagnosis and treatment of vision and learning conditions, strabismus, amblyopia, and neuro-rehabilitation. I realized that in order to truly specialize in vision therapy, I needed education beyond what I had learned in optometry school.
Hands-on VT courses are available throughout the year by the Optometric Extension Program (OEP), and at annual meetings of the following organizations:
- Neuro-Optometric Rehabilitation Association (NORA)
- College of Syntonic Optometry (CSO)
- International Sports Vision Association (ISVA).
- DigiVision also offers recordings of these training courses
In a field that’s so dynamic, it’s crucial that you’re always learning and growing. Committing myself to getting the education I needed before starting really helped me to add vision therapy to my practice.
Tip: Keep your patients in mind when designing your practice! I chose mostly light gray tones, as that is softer for our head trauma patients, but I have a few areas with a pop of color to spice it up.
An understanding of how billing works
Most primary care offices are in-network with a variety of medical plans, and not all plans cover vision therapy services. It is important to do your due diligence before enrolling a patient in vision therapy, so they understand whether these services will be covered. As a provider, you must understand the reimbursement rate offered by the insurance companies for vision therapy services prior to developing your business plan. This VT coding document from AOA was released several years ago, but it may be helpful as you determine codes and fees for VT services. Most importantly, you must make sure the codes you use are allowed in your state.
The necessary equipment
As a start-up sub-specialty, I had a very small budget for vision therapy equipment. I invested in a few pieces of equipment from Bernell, Good-Lite, and OEP. I gradually ordered more as I was able. My initial vision therapy equipment included:
- A whiteboard and markers
- A long 2x4 board, used as a balance beam
- Lifesaver cards: opaque & transparent
- Translucent eye patches—not the black pirate patches
- Red-eye patches for amblyopia
- Hand-made Brock strings
- A Quoits vectogram
- Laser pointers
- Computer-generated Hart Charts
- Red-Green glasses
- Polarized glasses
- Binders for my patients, to organize their home therapy instructions & equipment
- Yoked prism goggles, adult size, 6pd
- Accommodative flippers in a few powers to start
- Stick or square prisms: 4pd, 6pd and 8pd to start
- Minus lens blanks from our lab: -4.00 and -6.00 (eventually, -0.50 through -6.00 and +0.50 through +3.00 in 0.5D increments)
- Hand-made Marsden balls: large white balls and string, with eye hooks
- Parquetry Blocks
The right timing
After completing Dr. Sanet’s course, I took a six-year hiatus from vision therapy while raising my young children. Although I knew I wanted to do VT again, I was nervous to take the leap after so many years. Then the perfect patient walked through my door: a bright young girl who was struggling in school due to convergence insufficiency. I realized that I could significantly improve this child’s life, and now was the time to help her. Little did she know, she would be helping me as well.
A patient base
Start with straightforward diagnoses and then expand into more complicated cases. My patient’s convergence insufficiency resolved after just a few months of therapy. This gave me the confidence to see patients with other visual conditions: children with poor visual development, amblyopia, patients with exotropia (and later, esotropia) and neuro-rehabilitation cases.
Dr. Gabby Marshall gladly took me under her wing. She helped me with vision therapy techniques, gave advice on patient care, shared her Crystal Practice Management templates and helped me design my vision therapy program. Mentorship may happen in person or online. VTODs on Facebook, a group exclusively for optometrists and vision therapists, offers support for practitioners wanting help with cases, practice building or assistance with vision therapy techniques. In addition, VTODs on Facebook also offers a one-on-one mentorship program.
A strong referral network
In a primary care office with multiple doctors, in-house referrals are the easiest to obtain. Educate your fellow doctors so they understand which patients are good candidates for vision therapy. Besides optometrists, the following providers are excellent referral sources:
- Pediatric therapists: Occupational (OT), Physical (PT) and Speech therapists in town. Host a seminar so they understand the connection between vision & learning.
- Teachers: Some schools are more receptive to hosting educational seminars than others. Reach out to local public and private schools to offer a vision & learning presentation.
- Physiatrists, Sports Medicine physicians and rehabilitation therapists (PT, OT): educate them on post-concussion vision syndrome, and how optometry can help with lingering visual symptoms.
- Naturopaths and alternative medicine providers: Vision therapy is holistic in nature, so it resonates well with natural healthcare providers. Plus, these can be valuable resources for patients who have exhausted Western Medicine options but still have lingering or complicated health concerns.
As a primary care practice, we did not have a designated space for vision therapy. For two years, I performed the therapy in my 8’x12’ examination room. While not ideal, there was enough space for a balance beam, a whiteboard, and a hanging Marsden ball. Some therapy was performed in the hallway or even outside.
Ultimately, I opened a VT-only practice where I had two large rooms dedicated for vision therapy. Variable lighting is crucial as well, as many brain-injured patients experience extreme light sensitivity.
Every experience is an opportunity
I firmly believe that the doctor should have hands-on experience in the therapy room, especially as the practice is growing. This prepares the doctor to understand potential pitfalls or challenges in therapy, to anticipate patient reactions and how to guide your patient toward those “a-ha” moments. Remember, our role as therapists is to guide our patients toward discoveries, not to tell them what to expect. Once you have a wait list, then it’s time to hire and train a vision therapist.
I remember going home that evening after meeting my “perfect patient” with convergence insufficiency. My husband said, “If you start doing vision therapy again, you’re never going to stop.” Six years later, I have my own VT-only specialty clinic (no primary care, no optical), and I am living my dream. We help patients solve visual problems that others haven’t been able to properly diagnose. We have over 60 handprints on our walls of patients whose lives have been transformed through vision therapy. Recently, I visited a naturopath’s office in town, and the receptionist exclaimed, “You changed my daughter’s life with vision therapy!” And you can, too!