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Article Date: 12/1/2013

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VT compliance
SPECIALTY EYE CARE
VT compliance

How to Make Vision Therapy a Success

Help patients who have functional vision problems achieve their goals by improving your communication.

JENNIFER SIMONSON, O.D., F.C.O.V.D., BOULDER, COLO.

Have you ever been in a position where, after you carefully explain a binocular vision diagnosis, you find out later that the patient did not follow your instructions? The primary reason for this is a lack of patient understanding regarding the seriousness of their condition. This means we must provide clear information to patients who have functional vision problems.

Here are seven tips to help express the importance of vision therapy (VT), thus increasing compliance.

1 Provide a written prescription.

A written treatment plan conveys the importance of VT to resolve the patient’s symptoms and documents any referrals needed for specialized care.

Write a prescription for therapeutic lenses, prism, patching or in-office vision training the same way you would write one for a specific drug. Although you can write this on your prescription pad, it is more efficient to have a document that you can customize with simple checkboxes to explain the treatment plan. Utilize a template that is easy to edit and print individually for patients. (See “Sample Patching Prescription,” page 27.)

2 Present reading material on the diagnosis.

Patients tend to use the Internet to research their visual disorder and, thus, often find outdated or less-than-reputable information. Also, printed materials reinforce the information you provide. Provide a list of suggested websites, articles and books to steer your patients to current information, and consider starting a loaning library in your office that includes articles and books on VT. (See “Suggested Reading Material,” page 28.)

Also, the AOA (https://aoa.webprint.com) and the Optometric Extension Plan Foundation (www.oepf.org/products) have brochures available that describe common functional vision disorders, strabismus and amblyopia.

3 Provide an office policy sheet regarding VT.

Giving written office policies imparts responsibility on the patient to commit the time and effort required for successful treatment. Set expectations for the costs of VT, attendance policies and the dedication needed to complete home vision training.

Review policies with patients and parents verbally, and have them sign two copies: one to keep in their chart and another to take home.

Refer back to the policy form throughout treatment, and remind patients of their signed commitment to making improved visual function a priority.

4 Give written instructions and goals.

Though patients may understand your instructions in the office, they can forget after they leave. In addition, children may not practice home therapy with the same adult who brought them to their appointment, so a tutor, babysitter or grandparent may need to understand them.

Providing written directions improves a patients’ accuracy in performing therapeutic techniques. Many instructional videos are also available on YouTube for visual learners. Evaluate videos, and recommend specific links to ensure patients are following treatment as directed.

Along with instructions, write the patient’s goals on the first day of treatment. Make sure that the activities prescribed work toward both clinical improvements and functional objectives, such as decreasing symptoms.

5 Make yourself available for questions.

Oftentimes, questions come up after the patient leaves the office. Being accessible conveys the importance for the patient to understand the treatment plan. Also, some patients who have a question or misunderstanding may wait until their next appointment to ask, which can negatively affect treatment compliance. For example, if a patient is unsure how to perform their patching, they may not even attempt it themselves.

Be sure to provide them with multiple ways to contact you or the vision therapist: phone, e-mail, website, fax or text message. Also, consider providing patients with a VT tote bag or binder listing your phone number and website. Not only does it make the information easily accessible to the patient, it is a great billboard for your office.

Sample Patching Prescription

Your doctor has prescribed patching for the treatment of amblyopia. Please follow these instructions as directed. Remember to wear glasses or contact lenses when patching, so a clear image is on your amblyopic eye.

Your amblyopic eye is the:

Patch this eye:

Hours per day:

Days per week:

Type(s) of Patch recommended:

□ Adhesive bandage

□ Frosted lens

□ Blur foil, clear contact paper or transparent “magic” tape

□ Opaque contact lens

□ Patch (“Pirate-style” or patchworks)

□ Over-plussed optical lens (spectacle or contact lens)

□ Spectacle clip

□ Atropine penalization

Examples of activities to complete while patched:

□ Coloring in Os in books and magazines

□ Playing jacks

□ Coloring in coloring books

□ Solving jigsaw puzzles

□ Connecting dot-to-dot patterns

□ Playing with Legos and other blocks

□ Drawing: houses, faces, cars, etc.

□ Solving mazes

□ Playing marbles

□ Building models from kits: boats, cars

□ Stringing beads

□ Working on pegboard activities

□ Putting toothpicks in a straw

□ Playing pick-up sticks

□ Tracing

□ Reading books and magazines

□ Playing board games

□ Playing scrabble

□ Playing card games

□ Sorting objects

□ Playing dice games

□ Sewing

□ Reading comic books

□ Throwing games: baseball, darts

□ Working on craft projects

□ Playing with Tinker Toys

□ Solving crossword and Sudoku puzzles

□ Playing video and computer games

□ Hammering nails

6 Track progress with logs and reports.

How do you know whether patching is not working, or whether the patient is not patching at all? Ask patients to record the day, time spent on an activity and any notes or questions. Have patients rate the subjective difficulty of each exercise to ensure the activities are challenging and not too easy or difficult to perform.

As a reminder, tell them to hang the treatment log on their refrigerator to keep vision improvement on their minds during their day. Having a calendar or worksheet to complete improves compliance and your ability to judge whether the treatment plan is working.

In addition, aid patient compliance by providing the following reports:

Progress reports. Patients often comment that certain vision skills are improving, but they are unsure how much their vision has changed and how far they still need to go. In addition, some patients are confused when we try to explain that a larger range of convergence is better, but a smaller number of acuity size is better.

Table and graph reports can be much easier to understand, faster to create and more concise than a traditional letter. List the goal, normal range and test performance by date.

By graphing test result progress, you can more easily demonstrate improvements to patients to motivate them to continue complying to treatment while identifying difficult areas to emphasize.

Accommodation reports. Patients diagnosed with functional vision problems experience difficulties with school, work, driving and sports. Sending a report to teachers, coaches, occupational therapists, pediatricians and other health-care providers aids your treatment by educating them of your patients’ needs, which also generates referrals to your office.

Provide your patients with a list of classroom and work modifications, including visual ergonomics, to improve their comfort and performance.

Suggested Reading Material

Suggested Websites for Parents and Patients:

American Optometric Association Patients and Public section: www.aoa.org

College of Optometrists in Vision Development (COVD) Parent Resource Center: www.covd.org

COVD Research: http://www.covd.org/?page=Research

Optometric Exptension Program Foundation (OEPF): http://www.oepf.org/reference_articles

Optometrists Network public site: www.optometrists.org/public_eye_care.html

Optometrists Network on Strabismus: www.strabismus.org

Parents Active for Vision Education (PAVE): www.pavevision.org

Pediatric Eye Disease Investigator Group (PEDIG): http://pedig.jaeb.org/Publications.aspx

Vision and Learning Forum (VLF): www.vision-learning.org

Vision and Learning Forum summary: http://vision-learning.org/resources/vision-therapy-research-literature/

Vision Therapy Success Stories: www.visiontherapystories.org

VisionTherapy.org: http://www.visiontherapy.org/vision-therapy/vision-therapy-studies.html

Published Articles on VT:

● Cooper, J. Summary of Research on the Efficacy of Vision Therapy for Specific Visual Dysfunctions. The Journal of Behavioral Optometry 1998; 9(5):115-119.

● Convergence Insufficiency Treatment Trial Study Group. Randomized Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children. Arch Ophthalmol. 2008 Oct;126(10):1336-49.

● Ciuffreda, KJ. The Scientific Basis for and Efficacy of Optometric Vision Therapy in Nonstrabismic Accommodative and Vergence Disorders. Optometry. 2002 Dec;73(12):735-62.

Books on VT:

● “Fixing My Gaze” by Susan R. Barry (Basic Books, 2010)

● “Jillian’s Story: How Vision Therapy Changed My Daughter’s Life” by Robin and Jillian Benoit (The Small Press, 2012)

● “20/20 is Not Enough” by Dr. Arthur Seiderman and Dr. Steven Marcus (Fawcett, 1991)

● “When Your Child Struggles” by Dr. David Cook (Invision Press, 1992)

7 Schedule follow-up evaluations.

Patients demonstrate high motivation at the start of treatment. However, if the prescribed treatment is not working for the patient, treatment compliance may dwindle.

Modify the treatment plan by retesting the patient within four weeks. This time-frame allows you to assess success before patient frustration occurs.

After the follow-up evaluation, adjust the treatment plan if necessary. For example, if the patient is non-compliant with patching, a prescription for atropine penalization may be a better choice.

Discuss options with the patient at their follow-up appointments so they understand your recommendations.

Schedule the next follow-up appointment before the patient leaves your office. When the patient knows they will be re-evaluated in a specific time frame, they do not delay the start of treatment.

Convince patients of its worth.

VT is a high-value service, so make sure you provide active VT as a treatment option, regardless of age or perceived financial status. Once patients understand the impact their vision problem has on their daily lives, it is much easier to explain the time commitment and cost of VT.

Americans spend $3,000 to $7,000 on braces to make their teeth straight, according to The New York Times. After explaining this to patients, won’t they consider it worth at least that investment on their vision? OM

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Dr. Simonson is the clinical director of Boulder Valley Vision Therapy, PC in Boulder, Colo., where she specializes in vision therapy and rehabilitation. She is a fellow of the College of Optometrists in Vision Development and is on the planning committees of the Colorado Vision Summit and Colorado Vision Training Conference. She is the senior research optometrist for g-Labs, which designs vision therapy training equipment. E-mail her at bouldervt@yahoo.com, or send comments to optometricmanagement@gmail.com.



Optometric Management, Volume: 48 , Issue: December 2013, page(s): 26 - 33

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