Ah, the little people. Those patients in their earliest years trusting Vision Therapy to help guide their visual development. Who am I talking about? The toddler with a congenital Exotropia, the 2 year old developing an Accommodative Esotropia, the three year old wearing +6.00 correction who cannot help but clunking his head on EVERYTHING, and the four year old with no interest in books or anything within arm’s reach. When it comes to Vision Therapy, these young folks can be some of the cutest, sweetest, highly interesting, most uncooperative, tantrum throwing little lovable angels to ever grace your Vision Therapy room.  Definitely a hour’s pay for an hour’s work.

Been there. Done that. Got my t-shirt.

Many offices handle their patients differently from intake forms to length of Vision Therapy program, but as a population of practitioners we all hope to steer a universal direction – towards the successful patient.  The one question that seems to float my way often from my own patients, by email from those reading my blog and via social media is this one: How young is ‘too young’ to start VT?

The answer is both simple and complicated, so let’s deconstruct the question a bit to understand the variables.

The Short Answer – Could most people benefit in some way from Vision Therapy? Sure, even babies.  Just like most people could benefit from a Physical Therapist demonstrating personalized exercises for your particular body type. But as with most things in life, effective Vision Therapy can be a matter of timing and potential for progress at a given juncture; therefore, prudence demands that all angles be considered.

Diagnosis – This is an important factor in considering the efficacy of Vision Therapy for any patient, but in particular, those under 5 years old.  So much of what we do in the VT room is based upon patient feedback, and the more complex the diagnosis, the more detailed feedback required.  Knowing this, there may be times when allowing communication schemes to develop for six months or even a year before starting VT is the best decision.

Patient Compliance – This is a tough one for all therapists for one big reason – two year olds do what THEY want. When working with a patient under five years old, a large part of succeeding during the session lies in the preparation. Beyond the 15-20 activities we have ready to go in hopes of feeding a somewhat fleeting attention span – for frame of reference, we prepare 4-5 activities for adults – there is preparing the room. We hope to remove or secure as many shiny, glittery, colorful, chewable, “I need to touch this” items as possible. Making these sessions successful usually is a matter of offering the toddler options to play with that could easily be turned into an applicable activity. Not to be over simplified though, working with toddlers in this setting is tough, and certainly a skill set unto itself.

Doctor Expectations – This one is paramount, the doctor’s opinion. At the end of the day, the Developmental Optometrist is best suited to decide if their Vision Therapy program is suited to meet a particular patient’s needs. Usually, the answer is in the positive and life is good.  If on rare occasion the answer is in the negative, they cannot in good faith prescribe treatment program that may struggle to meet the patient’s needs – a measure of honesty that should be considered a gift for everyone involved. Like many other specialists outside of vision,  some offices are better equipped to manage care for toddlers, and some are not.  Remember, Vision Therapy is not a one-size fits all proposition.

Parent Expectations – What are your goals, and are they in alignment with what Vision Therapy can offer? Can Vision Therapy help your three year old read before they are developmentally ready? Probably not.  We can, however, nurture visual development and ensure the best visual circumstances as your child grows.  Sometimes this takes a few months, sometimes a few years. Vision is learned, and learning is never a continuous forward motion.  There are ebbs and flows. Sometimes the ascent is gradual and sometimes steep. Understanding this concept going in is important to all patients, but in particular to the parents of toddlers. Rather than ever expecting the quick fix, try to set your sights on the long term benefits of a well functioning visual system.

The BIG Fear  – To over promise and under deliver.  No one in Developmental Optometry wants treatment to fail, much less get paid for it.  We want all our patients to be successful and we work hard to ensure that they are, so sometimes, allowing a patient to mature provides the best opportunity for success.

Communication – Parents will often contact me and write that they’ve visited a Developmental Optometrist who diagnosed their 2 year old with a visual deficit, but will not recommend VT until their child is older.  Most doctors are more than happy to discuss what went into their decision as well as offering both short and long term solutions. Parents should always ask questions to better understand. We want you to understand.

Parenting is a marathon. Remember to pace yourself.


Posted on December 4, 2013, in From My Perspective.... Bookmark the permalink. 1 Comment.

  1. Timely blog as our office has exploded with early intervention patients. I’ll share this in staff meeting today because the discussion will be this population of patients!


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