Question: So how does the process start at your practice? Does a parent come to you and say that their child is skipping words and having trouble reading? At what stage does a child come to you and you start vision therapy?
Dr. Fuerst: Approximately 2/3 of our patients are referred to us by teachers, learning disability specialists, and other educators. The other third are patients that come into our practice on their own. We have a standardized questionnaire called CISS (conversion insufficiency signs and symptoms).
All parents of children 18 years of age and younger are given this questionnaire so we can pinpoint those kids who are having problems. A score of 15 or less on that questionnaire is considered normal. 16-20 is considered a child that may have potential learning difficulties and we need to keep an eye out.
Any score above 20 means the child’s vision is definitely adversely impacting their ability to read and learn. We will routinely get kids who are scoring in the 30’s and 40’s and the parents are just dumbfounded, saying the kids never told them they were having these issues reading or learning. The reason they most likely don’t mention it is because that is how the child has always seen – it was “normal” to them. In other words, they had no indication that they were seeing any differently than anyone else.
Question: can you describe a typical situation when a parent calls through a referral?
Dr. Fuerst: Sure. They would call and say that they were recommended to bring their child to my practice for a vision therapy work-up because [the person who referred them] thinks the child has a vision problem which is affecting his/her learning.
My call center then knows exactly what they are talking about, and then explains to them the process:
- Routine eye exam
- Sensory motor evaluation with our vision therapist
- Optometrist will test the binocular tracking accommodation skills
- All data will be compiled and explained to the parent and next steps will be discussed
Question: Of the people who come to you from referrals for vision therapy, how many really have issues related to that, and how many have something completely different?
Dr. Fuerst: The educators are very good at pinpointing the children who can benefit from visual therapy, and those who just have a skills issue. They have an over 90% success rate in their referrals. They are pretty sensitized to it. As far as those that show, after our evaluations, that vision therapy is needed, my success rate is close to 100%. I have been doing this for 35 years and we are very successful.
Question: Do you give the CISS questionnaire to all children or only those who are complaining of reading or learning problems?
Dr. Fuerst: The CISS questionnaire is given to every child 18 years and younger. The CISS questionnaire is part of a whole protocol to see if I need to delve further or not. We do this because most kids with these problems are not complaining at all. They have always seen this way and they don’t realize they are seeing abnormally.
Question: After the questionnaire is complete, you see if they need vision therapy or not?
Dr. Fuerst: We will know if we need to talk to them about it. We always give the CISS questionnaire and run a routine eye exam. Some of the biggest issues may be that they are 3-diopters far-sighted and didn’t realize it and they are struggling with their binocular vision and focusing, and with vision interfering with learning. In this case, all I need to do is get the child a pair of glasses and the child improves right away. They may not necessarily need to have vision therapy.
Basically, you can’t find what you are not looking for. Therefore, we run many tests, ask the right questions and speak to the parent and child. The CISS questionnaire gives us the opportunity to begin to say “Hey. You might want to look at this.” If the kid scores a one or two on the CISS questionnaire and I ask them “do you like school? do you like reading? do your read for fun?” and all of their answers are yes, then I know this is not a child with a problem.
Question: And if you see that this child can be helped by vision therapy, what is the next step?
Dr. Fuerst: First we explain to the parent the issues we found and the parents will usually confirm our findings, saying “Yes, you are right. I do see that our child hates to read and avoids it at all cost. When we do have her read to us, she is just jumping all over the place.” Moreover, the findings more often than not catch the parent off guard and they say “You never told us you see double!” or something like that.
In addition to wanting to discuss vision therapy with the patient and their parents, we still need to run a battery of other tests to check the health of the eye, for prescription, and if they need glasses, and other visual aids.
Therefore, we offer a complimentary vision screening, so they can learn a little more about vision therapy, where you will make a separate appointment to bring your child in to meet one of our vision therapists. This way the patients see what it is and learn a bit more about it without making any commitments.
After the therapist runs some tests, they will see if the child does indeed has some visual or perceptual issues that vision therapy can treat. At that stage, I would recommend they schedule a vision therapy work-up. The vision therapist will explain in detail what vision therapy is and what it costs. We will let the patient know that if you can figure out a way to fit this into your budget we would like to see them and take this further.