Article Date: 4/1/2009

Offering Vision Therapy for Children

Offering Vision Therapy for Children

If you'd like to bring kids — and interesting cases — into your practice, this may be the right field for you.

By Harvey F. Mazer, OD, FCOVD, Weston, Fla.

FOR ME, practicing optometry would get a little boring without kids. My longest days are those straight stretches of exam after exam. My young patients add spontaneity to the day, as well as especially challenging work.

My optometric work with children has gone through several transformations, from a strictly pediatric practice to a general practice with a specialty in developmental vision for children and adults. I perform many general exams and contact lens fittings for children and adults, from toddlers to seniors, but I take on some of my most interesting cases through my vision therapy and developmental vision care specialty.

Experiencing Vision Therapy

Vision therapy and developmental vision care are challenging areas, particularly when treating children. Despite completing a residency in this area, I wasn't fully prepared for the realities of working with children who have hyperactivity and attention deficit problems. Despite the challenges inherent in this field, searching for a visual component to these problems to help find a solution is fascinating and rewarding work.

Educators, occupational therapists, psychologists or other optometrists refer many pediatric patients to me. These patients may have learning-related vision problems, such as difficulty with reading, concentration or motor skills. From a 5-year-old with dyslexia to an adult with a brain injury, patients can benefit significantly from vision therapy.

Vision therapy changes the lives of many children and their families. After 3 months of therapy, parents tell me their child can finally read, pay attention or catch a ball. It's very emotional for these families, who often weren't aware of their children's full potential.

Getting Started

If you're interested in offering vision therapy for children in your practice, the first step is, of course, education. This specialty also requires investments in your facility and your staff.

Education and training. Residencies are available in vision therapy and developmental vision care, but they're not absolutely necessary, and a large majority of doctors who practice in this modality don't complete one. Learning opportunities are available in many places, including optometry schools, fellowships, annual meetings and conventions and the College of Optometrists in Vision Development. Once you begin to practice vision therapy, it's essential to stay educated and current on the latest pathologies and treatments.

Changes to your facility. If you offer vision therapy, you'll need a dedicated physical area. In my practice, our therapy room holds all of our vision therapy equipment, and it's always set up for treatment. This is a significant amount of space to dedicate to a niche specialty, but it's an absolute necessity. In addition, whether you're doing routine exams for children or performing vision therapy, you'll need to be prepared to serve children in your optical area, which may mean additional stock and training for your staff. (See "Is Your Optical Area Ready for Kids?")

You may want to take a fresh look at your reception area, as well. Kids will be naturally drawn to the part of the room that appears to be the "kids' area," with toys, videos or other enticements. In a general practice, setting up a special area for children can help alert your adult patients who may wish to sit separately from the children. Some practices schedule children in blocks, which creates some breathing room between pediatric and adult patients. Also, block scheduling makes it easier to have specialized pediatric staff members on hand when they're most needed.

Staffing considerations. In my practice, six staff members are dedicated to vision therapy, and they receive specialized training once a month. We also have a trained occupational therapist, who specializes in neuro-optometric rehabilitation, on staff.

Education, dedicated staff and a therapy room require sizable investments of both time and money. My advice is to start small and focus first on building a patient base.

Dr. Mazer is in practice at Town Center Optometry in Weston, Fla., with his wife and staff optician, Paula Mazer. You can reach Dr. Mazer at

Fitting Children for Spectacles
By Paula Mazer, licensed optician

From toddlers to teens, I fit children for eyeglasses quite often. Generally, I try to hold their interest to keep the fitting process moving along.
Keep these tips in mind when you fit kids for spectacles, and be sure to communicate with them and their parents.

Fitting Tots
When children and their parents walk into the optical area, I quickly tell them what the fitting process will entail, and then I delve right into it.
First, I determine which frames will fit. I tell parents the fitting process is similar to that in a children's shoe store: I measure the child first, and then select a style. From my perspective, this approach allows me to weed out many frames that won't fit, so we don't have to work backward and find out the frames a child likes best won't fit him.
I pull out a selection of frames and get to work on a rapid-fire process of elimination. Bridge fit is key, so we address that first. Toddlers, in particular, have undeveloped bridges, but bridge fit is very important for all kids. Few manufacturers have different bridge sizes — especially for childrens' frames. But once I find a bridge that fits, I check the front of the face and the rims along the sides and ears, which I can order in different sizes.
Once we know what fits, I'll choose about six or eight styles for the child to try. Then, I explain the different types of lenses and coatings available to the parents. All children get polycarbonate lenses with a scratch-resistant coating for durability. Some parents choose a nonglare coating or photochromic lens.

Communication Counts
In addition to explaining the fitting process to parents and kids, it's my job to educate them about their eyeglasses and how to take care of them. Of course, parents also need to know their children will have to be fit for new eyeglasses regularly as they grow. The challenging aspects of communicating with little ones and their parents can be the children's reluctance and the parents' role.
Parents can have strong opinions about their children's eyeglasses, and sometimes their opinions conflict with those of the child or the optician. However, parents generally want their kids to choose eyeglasses that make them happy so they'll wear them. I believe that as long as the child is old enough to have a preference, the child should choose the frames. This can boost their confidence and encourage them to wear their eyeglasses.
Of course, some kids don't want to wear eyeglasses, so they may be argumentative or sad. It helps to get through the fitting quickly and let them choose frames. I talk about how eyeglasses are a fashion choice, and most kids understand that. We have different designers that children recognize, with the idea that kids will be more likely to wear what they like.

Is Your Optical Area Ready for Kids?
By Paula Mazer, licensed optician

Because we're a large general practice, we sell a fair amount of eyeglasses for children and adults. To create and maintain an optical area that includes kids requires a little extra consideration. While the fitting concepts are always the same for both populations, fitting young children requires some special staff training and the following preparations:
Stocking childrens' frames. We stock many sizes of children's frames to ensure we can obtain a proper fit, as well as ensure they receive the comfort and style they want. What's more, we have a strong governing philosophy about children's eyeglasses: They must be sturdy and have a good warranty. Parents appreciate the fact that they can receive replacement frames for free within the first year.
Providing the right lenses and coatings. Most children get polycarbonate lenses with a manufacturer-warranted antireflective coating. Not only are polycarbonate lenses impact- and scratch-resistant for safety and durability, they also allow us to thin down high prescriptions to avoid the "coke-bottle" effect. Plus, they have built-in UV protection.
Focusing on quality. We're located in a city of 60,000 people with eight private optometric practices and no eyeglass retailers. Our philosophy is to focus on quality and service — and not try to beat anyone else's prices. Some parents buy inexpensive eyeglasses, and some choose pricier ones that are more durable or have special features. One of my 13-year-old patients received $600 frames, which her older sisters thought were cool. Parents appreciate that we help their children see clearly, look good and walk away happy.

Building Your Specialty

In addition to learning about vision therapy, it's important from a business perspective to evaluate the availability of this therapy in your local area. In my community, I'm the only optometrist who offers vision therapy for children. We don't do any advertising. We get all of our patients through word of mouth, community efforts and referrals from other doctors, teachers and occupational therapists.

Community outreach at the Lion's club, churches and temples is important, but to get kids into the practice, you must be involved with the local schools and youth sports programs. You may not see referrals from these places for several months, and what may be a good referral source one year can dry up the next, so your efforts to build your patient base in this area will be ongoing.

The best way to make the most of referrals from optometrists, teachers and others is to maintain your professionalism at all times. Every time a professional refers a patient to me, I send a letter within a week acknowledging the referral and updating the referring physician about the patient's progress or outcome.

Finally, I've learned that testimonials from patients really stick with people. When a child is able to sit through class or play more easily with others, his family is deeply affected. On display at our front desk is a letter from a young mother who describes how vision therapy changed her daughter's life. The letter sparks conversations with patients in our practice who may be interested in learning about vision therapy or may tell their friends who have children who may need vision therapy.

In short, the same things that make vision therapy for kids fascinating for practitioners also help us grow our practices. nOD

Optometric Management, Issue: April 2009