- What is the difference between an ophthalmologist and optometrist?
Optometrists are eye doctors trained to diagnose and treat eye conditions, emergencies, infections and diseases such as "pink eye" and foreign body removal. Most optometrists are trained and certified to administer drugs to treat these problems when necessary. Many optometrists perform pre- and post- operative care for eye surgeries including cataracts, retinal detachments, laser refractive surgeries and diabetic retinopathy.
Training includes 4 years of undergraduate study and 4 years of graduate study and includes several years in how to prescribe glasses and contacts for clarity of sight, treatment and management of eye disease and neurological disorders, training eye movements (how our eyes work together), vergence (how we point our eyes), accommodation (sustaining and changing our focus), visual perceptual skills (information processing, spatial skills, visualization, memory), and eye-hand coordination (gross and fine motor skills).
Within optometry, there are several different modes of practice. There is general practice, usually called primary care, or specialty practices. Some of these specialties include contact lenses, refractive surgery co-management, dry eye, disease, glaucoma, geriatrics, low vision, neuro-rehabilitative optometry, sports vision, developmental/ behavioral optometry, pediatrics, vision training, and learning disabilities. Optometrists can also choose to go into vision research or teaching.
Primary care optometrists can be thought of as the family or general eye doctor. If surgery or specialty medical care is required, they are referred to the proper specialist. This can sometimes be another type of optometrist and sometimes it can be the ophthalmologist.
There are fellowship programs available to optometrists to become an officially recognized specialist in their field by their colleagues. These programs require that the candidate prove their knowledge by rigorous training, experience in the field, publishing, testing and interviewing by the fellowship committees before fellowship is granted. One such fellowship program is offered by the College of Optometrists in Vision Development (COVD). A COVD fellow is a person that specializes in vision training and binocular vision. Another fellowship program is offered by the American Academy of Optometry (AAO). The AAO has several different specialties that they recognize and each fellowship requirements vary. Some of the subspecialties are Binocular Vision, Perception and Pediatric Optometry, Cornea and Contact Lenses, Disease and Low Vision.
Ophthalmologists are surgeons that spend four years in a graduate program beyond an undergraduate degree, but their program is in medicine or osteopathy. They study systemic disease, including diagnosis, treatment and management. Once they earn their general medical degree (M.D.) or osteopathic degree (D.O.), they also go on to do a four-year residency specializing in the treatment and management of eye diseases including surgery in order to earn the title of ophthalmologist (also D.O.).
Residency includes learning how to manage and treat eye conditions, infections and diseases and also co-manage the systemic problems that can affect the eyes. They also get roughly 6 weeks of training in refraction, depending on the residency, so they can prescribe glasses and contacts if they choose. It is rare for residency programs to teach visual function.
Most of their training is in eye surgery including the following: removal of cataracts, retinal tears, retinal detachment, hemorrhages, tumors, strabismus surgery, plastic reconstructive surgery of the eye and surrounding structures, refractive surgery, and surgical treatment and management of glaucoma diabetic retinopathy and hypertensive retinopathy.
Just like optometrists, they can choose to specialize in any one area such as oculoplastics, neuro-ophthalmology, cornea, retina, glaucoma, pediatrics and strabismus. They can also choose to go into vision research or teaching.
Most of the time, optometrists and ophthalmologists work in conjunction with each other. Some work in the same offices to co-manage patients. Other times, they can disagree on their philosophies of care and treatment strategies based on their training, especially when it comes to visual function. Many ophthalmologists are not trained in vision therapy and are not exposed to the scientific research that proves the validity of vision training. There are some wonderful collaborative, longitudinal studies occurring between both professions that have changed protocols and standards of care in both professions.
If you see an ophthalmologist and want a second opinion from an optometrist about visual function, or vice versa, it is almost a guarantee that they will give you different insights and professional opinions due to their different training backgrounds. This is because opinions from different eyecare providers is not a second opinion, but really a different opinion altogether.
- What is a neuro-optometrist?
Neuro-Optometrists (aka Behavioral Optometrists, Developmental Optometrists) assess the performance of vision and how it is integrated with all the other senses using advanced technology, neuro-visual testing and traditional evaluation methods. Our doctors are specialists who diagnose and treat visual inefficiencies or delays because our goal is for every person to reach their full potential. Neuro-optometrists not only perform routine eye exams, they also work closely with infant vision, developmental delay, special needs, vision related learning problems, sports enhancement, strabismus, amblyopia and acquired brain injury.
Optometrists who successfully complete the rigorous certification process of The College of Optometrists in Vision Development (COVD) International Examination and Certification Board, they become Board Certified in Vision Development and Vision Therapy. You can identify Fellows of COVD by looking for the FCOVD designation after the doctors’ name.
- How come my child passed the school screening, yet your exam showed that they have significant vision problems?
You can have 20/20 visual acuity in the distance and still have a vision problem that affects performance. School screenings and most pediatric screenings can miss up to 51% of vision problems that can affect academic performance simply because they will only screen for distance visual acuity and sometimes health. How clear you see and how healthy your eyes are have a very small part in how the eyes and brain function together. Vision screenings should also include at the very least depth perception, eye teaming, focusing, eye movement control and form perception.
Our offices are committed to ensuring that everyone’s vision is healthy and fully functional. We provide vision screenings periodially at no cost on-site and at little or no cost off-site as part of our community service. If you are interested in a free performance vision screening, please contact us!
- What is the difference between a school vision screening and a visit with the eye doctor?
A vision screening only determines if you are at risk of having a potential problem. A full examination will confirm or rule out a vision problem through extensive testing. It is like getting your blood pressure checked at a station in a drug store. It can flag you that you may have a problem, but a health examination and blood work will determine whether or not you truly have heart disease or hypertension. Diagnosing a health problem, including a visual problem, requires several tests and analysis by your health care practitioner.
- How will I know if my child is having any vision difficulty?
Many children who have problems adjusting to school demands may have underlying, undetected vision problems. The best way to know is have your child examined.
- My child has seen a specialist at school and was given colored overlays for Photopic Sensitivity or Irlen Syndrome. Does your center diagnose or confirm the diagnosis of Irlen Syndrome?
At the Vision Learning Center, we seek to treat the problems and not the symptoms, so we do not test for Irlen Syndrome. There are other ways to put the visual system in balance, even in a compensatory way.
Research shows that up to 95% of subjects identified as having Irlen Syndrome had significant and readily identifiable vision anomalies such as refractive error, binocular or eye movement control problems. Though marketing materials for Irlen diagnostic testing states that clients are encouraged to have a comprehensive vision exam, research studies also show that only 57% of clients have received vision care. Of those clients identified as having Irlen Syndrome, 90% of them still had significant uncorrected vision problems which could be remediated.
Our advice to you is to get a full vision exam to diagnose the cause of the symptoms so that the problem can be eliminated.
Though colored overlays can temporarily improve reading because of how it changes the awareness of a particular part of the visual pathway, in most cases it is only addressing the signs and symptoms, not the underlying problem. The signs and symptoms that Irlen claims to be helping are the same as those exhibited in patients diagnosed with vision related learning difficulties. The filters can have a temporary affect, but if the underlying vision problem is not treated, frequent filter changes need to occur to achieve a positive response.
If the overlays used are helping your child reduce their symptoms, continue to use them. There are many accommodations/lenses/filters we can use to make it easier until the necessary skills are in place to support academic achievement.
- When should my child?s eyes be examined?
According to the American Optometric Association (AOA), infants should have their first comprehensive eye exam at 6 months of age. If there are no risk factors or interventions, children then should receive additional eye exams at 3 years of age, and just before they enter kindergarten or the first grade at about age 5 or 6.
For school-aged children, the AOA recommends an eye exam every two years if no vision correction or intervention is required. Children who need eyeglasses or contact lenses should be examined annually or according to their eye doctor’s recommendations.
Early eye exams also are important because children need the following basic visual skills for learning:
- Near vision
- Distance vision
- Eye teaming (binocularity) skills
- Eye movement skills
- Focusing skills
- Peripheral awareness
- Eye/hand coordination
Because of the importance of good vision for learning, some states, like Kentucky, require an eye exam for all children entering school for the first time.
- How much does an eye examination cost?
The cost of an eye exam varies depending on the depth of the suspected visual problem, which is determined by referral information, academic history, reported symptoms, etc. At the Vision Learning Center of Champions office, a new patient primary care exam starts at $110. If there are any academic or developmental concerns, a neuro-visual analysis is recommended. This cost starts at $180. Full testing is done in combination with testing at our Bellaire testing center. Prices vary depending on what the doctor orders for testing.
- Does the Vision Learning Centers accept insurance for examinations?
Major medical insurance is often used to pay for our services. Some of the diagnostic testing that is often required when looking at the entire visual system is done at our NeuroSensory Center in Bellaire, and major medical insurance is billed directly through that company for services.
The Vision Learning Centers are out-of-network providers and do not accept insurance assignment directly. Only the Champions location actually does full vision evaluations at its location. At the Bellaire location, exams are provided through Bellaire Family Eye Care. Bellaire Family Eye Care accepts some vision or major medical insurance for the initial eye examination. This means that some of the initial exam cost is out-of-pocket but can be billed by you to your provider. Most insurance plans provide “out of network” coverage and will reimburse you directly. Reimbursement is dependent on your carrier and the particular plan your employer opted for. To be certain of your “medical out of network” benefit contact your insurance company. We will prepare reimbursement paperwork for you at no charge after your visit.
- Will my health insurance cover Neuro-Visual Testing?
Sensory View Diagnostic Testing is approved by Medicare and most major medical insurance carriers. However, insurance is a contract between you and your insurance carrier. It is possible that some testing may be denied payment by your insurance carrier based on your contract. You may also need to get prior approval from your insurance carrier before services are covered.
Our office will do our very best to pre-certify these tests with your carrier and keep you informed of your obligation prior to testing. However, we recommend that you also check with your insurance carrier for any pre-certification clauses in your policy, since you will be ultimately responsible for disallowed charges.
- When will I get the results from all the testing?
A follow-up consultation appointment with the doctor will be required to discuss testing results and recommendations. The consult will be scheduled on a different day, typically one to two weeks after the Sensory View Diagnostic Testing, which allows enough time for the doctor to thoroughly review the results and write a comprehensive report. If neurosensory testing is undergone, a Sensory View report will be included with the extensive report you will receive during your initial consult with the doctor.
- Do I need a consult with the doctor or can I have my results sent to me by email?
The consult is required, as it is an important time to really understand how vision and other sensory-motor systems are performing and how they impact you/your child’s overall potential. It is during the consult the doctor will explain ALL the results from the comprehensive vision exam, sensory-motor evaluation, neuro-visual processing evaluation and Sensory View Diagnostic Testing. You will learn how well the sensory-motor systems are working and how well vision is leading as the dominant sense. If the doctor identifies any inefficiencies, a comprehensive treatment plan will be presented to you, including possible referrals to other professionals.
- What is Neuro-Visual Therapy?
Vision Therapy is individually prescribed treatment programs prescribed and monitored by the doctor to remediate visual delays or inefficiencies. Exercises and techniques are designed to support, integrate and enhance visual input and processing skills, eye-hand coordination, movement, balance, attention, learning and cognitive skills.
It is prescribed after results from a comprehensive eye examination and most often a further visual analysis indicates that vision therapy is an appropriate treatment option. The vision therapy program is based on the results of standardized tests, the needs of the patient, and the patient's signs and symptoms. The use of lenses, prisms, filters, occluders, specialized instruments, and computer programs is an integral part of vision therapy.
Vision therapy is administered in the office under the guidance of the doctor. It requires a number of office visits and depending on the severity of the diagnosed conditions, the length of the program typically ranges from several weeks to several months. Activities paralleling in-office techniques are typically taught to the patient to be practiced at home to reinforce the developing visual skills.
Research has demonstrated vision therapy can be an effective treatment option. Some examples of vision problems remediated in vision therapy:
- Ocular motility dysfunctions (eye movement disorders)
- Non-strabismic binocular disorders (inefficient eye teaming)
- Strabismus (misalignment of the eyes)
- Amblyopia (poorly developed vision)
- Accommodative disorders (focusing problems)
- Visual information processing disorders, including visual-motor integration and integration with other sensory modalities
- Is Neuro-Visual Therapy covered by insurance?
With proper documentation, a number of our patients have had success gaining insurance coverage for therapy from several carriers. Many major medical insurance PPO or POS plans do have vision therapy coverage. Once services are rendered, statements can be sent to your carrier for reimbursement directly by you.
Our office is an out-of-network provider and we do not submit directly to insurance. Patients are responsible for verifying insurance coverage, as the insurance company is bound by privacy laws to not give information to providers not in their network. Remember that your co-insurance rate will be based on the out-of-network rates.
- How much does it cost for Neuro-Visual Therapy?
Vision Therapy is individually prescribed, so the cost of treatment varies depending on the extent of the problem being treated. Neuro-visual therapy sessions are $140 per session. Discounts are offered based on the payment option chosen. Treatment programs typically range from 4 months to 1 year and can be one to two visits per week. Contact Vision Learning Center for more details.
- Do you work with individuals with Autism Spectrum Disorder, Dyslexia, ADD, ADHD and Developmental Delay?
Yes! If there are any delays in development or sensory-m otor integration issues, most often vision is also affected and can be remediated. If there are any attentional, reading or learning issues, vision problems should be ruled out. Many signs and symptoms of ADD or Dyslexia mirror the signs and symptoms of a vision problem.
- Do you sell contacts and glasses?
Yes, we have a large variety for all ages to choose from either at Bellaire Family Eye Care or at Vision Learning Center of Champions. To see our selection, please stop in and someone would be happy to assist you.
- Is a comprehensive exam needed for contact lenses?
Yes, before being fit with contact lenses, a comprehensive eye exam must be performed. In the exam, your eye doctor determines your prescription for corrective lenses and checks for any eye health problems or other issues that may interfere with successful contact lens wear.
If all looks good during your eye exam, the next step is a contact lens consultation and fitting. The fee for contact lens services varies depending on the type of contact that is needed. If you already wear contact lenses and know the type of contacts you were, i.e. spherical, toric, monovision, soft, rigid, etc. our staff can better quote a service fee for the visit.
All subsequent follow up visits are included in the initial contact lens fee.
- Do you take appointments on Saturday and Sunday?
Our offices are open for regular eye examination appointments Monday through Friday from 8:30am-5:30pm (Friday hours vary at the Bellaire locations). Saturday appointment times are reserved for vision therapy sessions only and we are closed on Sunday.
- Do you perform LASIK eye surgery?
LASIK refractive surgery and other methods of refractive surgery are done by your ophthalmologist. Optometrists provide the pre and post-surgical care. Our doctors do work closely with refractive surgeons and provide the co-management you need to ensure a successful surgery. The advantage of working with a neuro-optometrist as your co-managing eye doctor is that we can ensure that functional complications will not arise after surgery. For example, if you are nearsighted and have undiagnosed convergence insufficiency, after LASIK surgery, there is a possibility of double vision if the convergence insufficiency is not addressed. If you are interested in refractive surgery, give us a call and we can send you some information.