Carla D. Adams, OD, MEd.
Independent optometrists now compete not just with other independent ODs down the street, but with corporate-owned vision chains and online eyewear retailers. Being the kind of generalist that offers the same services patients can find for less cost elsewhere is no longer enough to remain profitable. For my Chicago area practice, vision therapy is a differentiating specialty that gives me an edge over the competition.
St. Charles, Ill.Started Cold, 2010Number of Locations: 1
Number of Doctors: 1
Mix of Patients: Full-scope practice including refraction, as well as medical eyecare. Only patients with advanced pathology are referred out.
Vision Therapy: 15-20 percent of patients
Annual Revenues: Approx. $550,000
Vision therapy is less prone to competition from the larger optical chains. It allows you to change the lives of others and have the satisfaction of working in a stimulating way–beyond the “better or worse” repetition of refraction. Shortly after opening my private practice at the height of the bear market in 2010, I embraced pediatrics and vision therapy. Vision therapy has not only helped my new office survive; it has also been a source of personal satisfaction.
Get Started: Educate Yourself and Purchase VT Starter Kit
The pediatric and vision therapy classes taught in optometry colleges are only the beginning of what you need to know about vision therapy to make it a specialty. If you are willing to treat cases other than binocular vision problems, then your armamentarium must include specialty cases like traumatic brain injury (TBI), and an understanding of how to use prisms to change behavior, not just vision. Being involved in organizations such as College of Optometry in Visual Development (COVD) and Optometric Extension Program (OEP) is a necessity. They host educational meetings and sell specialty media that are “must reads” and very inspiring.
Bernell and Good-Lite are two of the best known companies that sell “starter kits” for a vision therapy practice. Expect to pay about $3,500 for this starter kit. You can break even after two patients, assuming the patient is not using an insurance which discounts your services. I try to invest in a new piece of vision therapy-related equipment every year.
Network with Other Doctors to Generate Referrals
Optometrists who do not provide vision therapy are a potential referral source. They are the first to encounter the average patient who is struggling in school. Many eyecare professionals are focused on providing clear eyesight. However, eyeglasses do not solve reading and some eye teaming problems. All eyecare professionals in your community should be periodically reminded that amblyopia, strabismus, as well as binocular vision problems, can respond well to therapy. Let these doctors know that each of these patients should be made aware that therapy in your office is an option.
Other potential referral sources are: physical therapists, occupational therapists, tutors and pediatricians. A collaborative partnership should be formed with these professionals in your area, in which you also refer to them when appropriate.
Patients Will Mostly Pay Out-of-Pocket; Offer Patient Financing Options
It is difficult to get insurance companies to pay for vision therapy. We are providers of CareCredit which helps some families who otherwise might not be able to afford vision therapy. The latest trend among insurance companies is to require the patient to complete a 12-week, software-based home therapy program. The need for vision therapy is then reevaluated. This is a poor strategy for most patients, especially patients who are strabismic and cannot use the software, and it definitely does not work for very young patients.
Dr. Adams with one of her vision therapy patients in her practice, Optique Eyecare, in St. Charles, Ill.
When insurance can be applied, I have found the procedure code 92065 to be useful, and whenever possible I use the diagnosis 368.83 for convergence insufficiency.
I offer a tiered payment structure. Patients who pay the entire fee upfront get the most competitive cost. Pay-per-session is also an option, but the most costly. The severity of diagnosis determines which track of office visits a patient is enrolled in. Our tracks are 12, 24 and 36 weeks. On average, I see patients three to six months. The visual efficiency exam usually lasts 1.5 hours, however the actual therapy sessions last less than 35-40 minutes.
Long-Term Patient Impact: Success Measures
I define vision therapy as a way of changing a person’s vision. This change should result in improved behavior and function. My typical patient is a student who is struggling academically. This could be a patient who avoids reading, reverses letter or words, or who is generally doing poorly in school. We do formal evaluations at specific intervals during therapy. Also, we ask for subjective awareness of improvements in academics and general well being. Typical responses include improvement in reading, grades, less double vision and improvement in sports.
I now have several patients who finished therapy more than 18 months ago. The visual skills have remained strong even in the patients with severe diagnosis. I prescribe maintenance techniques that take just a couple of minutes per week. I explain to the patient (or parent with a toddler) who has successfully completed a vision therapy program that maintaining strong visual skills is worth the effort.
One of my most memorable cases is a congenital post-surgical esotrope. Before starting vision therapy he had very little stereopsis and an obvious eye turn and reported challenges playing hockey and reading. All those things were a distant memory after a mere six months of therapy. Patients who have encountered head trauma, patients with unusual posture (e.g.: head tilts and stooped posture), amblyopes and strabismus patients are treatable within the realm of vision therapy.
ROB’s GET STARTED…ON VISION THERAPY