What Vision Therapy Can Add to Your Practice
Vision Therapy (VT) may not be part of your practice today. If you are considering retirement from your optometry practice, adding VT now opens up a stream of new patients and will enhance your practice value. I want to thank Dr. Nathan Bonilla-Warford, OD for contributing this very thorough article on what VT has done for his practice. – John Scibal, OD
By: Nathan Bonilla-Warford, OD
I graduated from Illinois College of Optometry in 2004, which is long enough to see trends, but not so long that I am ready to throw in the towel. Some trends are exciting, like the increasing application of myopia control and the quality of contact lenses. Of the many worrisome trends, two are: decreasing third-party reimbursements and
retiring doctors closing practices because they cannot find a younger doctor to purchase the practice.
Benefit of No Reimbursement
While there is no magic bullet for 21st century practice, I have found that looking to some 20th century services has greatly benefited my practice. These are services that benefit the patient, are highly sought after, do not depend on third-parties for reimbursement, and are a component of my exit-strategy when I eventually want to retire.
Specially, I am talking about providing “a sequence of neurosensory and neuromuscular activities individually prescribed and monitored by the doctor to develop, rehabilitate and enhance visual skills and processing”. This may sound high-tech, but it actually is how the American Optometric Association defines vision therapy.
Need for Vision Therapy
There is a great need for vision therapy. As stated in the AOA’s Practice Guideline on Accommodative and Vergence Dysfunctions, “these dysfunctions can interfere with a child’s school performance, prevent an athlete from performing at his or her highest level of ability, or impair one’s ability to function efficiently at work.” That covers a lot of patients. The most common binocular vision disorder is convergence insufficiency, which has a prevalence estimated at approximately 1 in 20 people. Consider also patients with amblyopia, strabismus, learning-related vision problems, and visual dysfunctions secondary to brain injury and it becomes evident that every community includes individuals who would benefit from vision therapy.
Since I opened Bright Eyes Family Vision Care in 2006, vision therapy has been an important part of the practice. It has allowed me to:
• Be less dependent on vision plans and insurance companies.
• Be less dependent on optical sales
• Grow even during the recent recession.
• Afford to hire additional sales and support staff
• Add an associate doctor with top-notch specialty training
• Open a specialized pediatric-only location Bright Eyes Kids
• Most importantly, vision therapy has significantly improved the lives of hundreds of my patients and their families.
I’ll be honest. Optometry schools do not do a great job of teaching vision therapy in practice. Because of this, many new optometrists fail to embrace this aspect of care which not only has powerful scientific research supporting it but is wholly and entirely optometric.
Some optometry students have gotten the idea that vision therapy is an “all or nothing” proposition – that you cannot provide vision therapy unless you have a gymnasium-sized therapy room and a platoon of therapists. In my opinion, this simply is not true. I started providing vision therapy in a 900 square foot office with one exam lane. Some optometrists provide vision therapy in retail-affiliated practices.
Vision Therapy Steps
If you are interested in providing vision therapy here are steps I suggest you take:
1. Visit some vision therapy providers.
Because there is a great unmet need for vision therapy, doctors are very happy to have interested colleagues shadow them and learn about their practice. I have frequently have optometry students and doctors visit and ask questions.
2. Decide if vision therapy is right for your practice.
Do you like longer-term care? Vision therapy takes time and requires strong relationships. Are you currently in the process of adding specialty services such as Orthokeratology or dry eye? You might want to wait awhile before pursuing vision therapy.
3. Read, read, read!
You can learn a great deal from the comfort of your desk or couch. Books such as Fixing My Gaze and Jillian’s Story as well as open journals like Optometry and Visual Performance are a great place to start.
4. Start small.
I recommend starting with the types of cases where can’t help but improve the symptoms of the patient – like convergence insufficiency. With these cases you can learn what to expect and train your staff. You do not need to spend tens of thousands of new equipment; Bernell has inexpensive starter kits.
5. Attend meetings.
There is no better way to get excited about vision therapy and network with peers than to attend a big meeting like the annual College of Optometrists and Vision Development meeting.
6. Get the word out!
The success and science of vision therapy make great content for sharing via social media. See my blog for an example. Keep in mind that promoting vision therapy also involves networking with professionals such as occupational therapists, pediatricians, and educators.
7. Hire a consultant.
When you are adding a segment of your practice, it is helpful to not have to “reinvent the wheel”. A good consultant can help you see the things that you don’t because you are too close to the action. Yes, consultants require money, but if you follow through, they easily pay off many times over.
Vision therapy is good for patients and great for practices. I am confident that for the willing optometrist, vision therapy can not only provide a necessary service for patients in the community, but keep the practice viable over the owner’s career. This allows for long-term planning, including exit negotiation with an associate or between partners. Many optometrists continue to work part time because they love helping patients. Others dedicate their time to golf and fishing. But the choice is theirs – not a third party.