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Vision therapy: Can we train our sight?
Table of Contents
What is vision therapy?
Who, What, When, and How Long?
What is vision therapy NOT?
Optometrists vs. Ophthalmologists
What does the research say?
Problems with vision therapy
The American Optometric Association defines vision therapy (VT) as a “treatment plan used to correct or improve specific dysfunctions of the vision system. It includes, but is not limited to, the treatment of strabismus (turned eye), other dysfunctions of binocularity (eye teaming), amblyopic (lazy eye), accommodation (eye focusing), ocular motor function (general eye movement ability), and visual-perception-motor abilities. Optometric vision therapy is based upon a medically necessary plan of treatment which is designed to improve specific vision dysfunctions determined by standardized diagnostic criteria. Treatment plans encompass lenses, prisms, occlusion (eye patching), and other appropriate materials, modalities, and equipment (http://www.children-special-needs.org/vision_therapy/optometric_vision_therapy.html).”
Vision therapy, also known as eye exercise, vision training, or orthoptics, (for a definition of these and other vision terms, go to this glossary of terms) is a non-surgical, physical therapy for binocular visual problems; however, vision therapy is not a direct treatment for learning disabilities (http://www.visiontherapy.org/).
Patients of any age can undergo vision therapy, but the treatment varies with each individual based on condition.
Successful vision therapy enhances and improves visual abilities such as fixation, acuity, visual memory, and binocular fusion, to name a few. Treatment plans involve prisms, lenses, computer modalities, and other materials.
The estimated program consists of weekly office visits, along with therapies to be conducted at home.
The treatment requires a great deal of commitment, for it may last for extensive periods of time depending on the individual. However, research has shown that the improvements due to vision therapy continue post-treatment (http://www.children-special-needs.org/questions_pf.html).
Further information regarding the dynamics of vision therapy may be located here.
It is important not to confuse optometric vision therapy with holistic practices such as the Bates Method, integrated vision therapy, or natural eye exercises. There is no scientific research or results that indicate these methods are valid; however, the internet is swarming with advertisements and descriptions of products that claim otherwise (http://www.vision-therapy.com).
The See Clearly Method is a series of daily eye exercises that claim to naturally reduce the need for glasses or contact lenses by toning and relaxing your eye muscles and relieving stress that hampers clear vision (http://www.seeclearlymethod.com/content/see clear.html).
A similar program called Vision for Life provides daily optical exercises that claim to stimulate and strengthen the muscles of the eye, resulting in improved vision and decreasing the dependency on glasses or contact lenses. Through testimonials, quotes, and flashy pictures, the Vision for Life website attempts to promote their method of natural vision improvement (http://www.rebuildyourvision.com).
Yoga is another branch of holistic therapy for vision. Yoga exercises claim to stretch, relax, and tone the optical nerves, which improves eyesight and alleviates tension, irritability, and itchiness of the eyes (http://www.indolink.com/Vasantha/eyeYoga.html).
The Bates Method is a psychosomatic approach to vision impairment. Without using strengthening exercises for the eye muscles, the Bates Method claims to improve visual clarity through relaxation exercises (http://www.seeing.org).
Several examples of holistic eye exercises can be found at Holistic-online.
An optometrist is licensed by the state to provide primary eye care, while an ophthalmologist is a physician of osteopathy who specializes in prevention of eye disease, eye care, and the visual system. The ophthalmologist is medically trained and licensed in all eye care, and is not trained in vision therapy.
Thus, support of vision therapy in the United States mainly comes from optometrists. Vision therapy saw its beginnings in the late 1800’s in orthoptics, which is the science of correcting binocular vision impairments, and is now a form of vision therapy (http://www.vision-therapy.com/Glossary_of_Terms.htm). Present day ophthalmologists, for the most part, do not support vision therapy, and it has been speculated that this is due to the fact that they are trained to use drugs and surgery to treat eye dysfunction (http://www.children-special-needs.org/questions_pf.html).
There have been several concerns regarding the reliability and validity of the research surrounding the efficacy of vision therapy (http://members.aol.com/scottolitsky/vt.htm).
The sample population is not random, there are small numbers of patients in each study, and the results cannot be generalized because it does not reflect the population
Research that shows support of vision therapy have conflicts of interest in proving the
validity of vision therapy
There are many definitions of “vision therapy” found on the internet and in research studies. Thus, most of the data cannot be compared or generalized because vision therapy is defined differently (Coffey, B., Wick, B., Cotter, S., Scharre, J., & Horner, D., 1992).
Eye exercises, lenses, and perceptual training have not been scientifically proven to be useful. In addition, the problems that they intend to treat have never been proven to cause a learning disability.
As well, the American Academy of Ophthalmology and the American Academy of
Pediatrics made this statement regarding vision therapy:
No scientific evidence supports claims that the academic abilities of children with learning disabilities can be improved with treatments that are based on 1) visual training, including muscle exercises, ocular pursuit, tracking exercises, or 'training' glasses (with or without bifocals or prisms), 2) neurologic organizational training (laterality training, crawling, balance board, perceptual training), or 3) colored lenses. These more controversial methods of treatment may give parents and teachers a false sense of security that a child's reading difficulties are being addressed, which may delay proper instruction or remediation. The expense of these methods is unwarranted, and they cannot be substituted for appropriate educational measures. Claims of improved reading ... are almost always based on poorly controlled studies that typically rely on anecdotal information. These methods are without scientific validation. Their reported benefits can be explained by the traditional educational remedial techniques with which they are usually combined. (http://www.allaboutvision.com/parents/vision_therapy.htm)
A study by Adler (2002) concluded that vision therapy is an effective treatment for convergence insufficiency. The restoration of near point of convergence values to normal accompanied by a reduction in symptoms was concluded as successful treatment. Routine eye exercises were shown to have a highly significant (t = 14.61, p < 0.001) effect. Although treatment times were longer, the rate of success was greater than that reported by previous studies. As well, Verma & Singh (1997) reported that active visual therapy improved visual impairments in amblyopic children and young adults. The study used various methods of therapy on 160 patients, ranging from 3.5 to 25 years of age, who had lens implants, and visual acuity improved in the majority of the patients.
However, research surrounding the effects of visual therapy on learning disabilities has had mixed results. Having a visual impairment does not result in a learning disability, nor does the treatment of the impairment cure the disability. In fact, according to this study, there has been no scientific evidence for the efficacy of eye exercises in the elimination of the learning difficulties (Learning disabilities, dyslexia, and vision: a subject review, 1998). Vision therapy does not claim to directly treat the learning disability; however, it is an indirect influence, for it treats the visual impairments that influence reading and learning (http://www.visiontherapy.org). Research by Simons & Grisham (1987) supports a relationship between particular binocular disorders and reading problems. From these results, it can be hypothesized that if binocular disorders are alleviated, the reading disability, due to the positive correlation, will be less severe (Simons & Grisham, 1987).
Further research studies on the effects of vision therapy for eye disorders:
Accomodative Disorders (eye focusing problems)
Binocularity Dysfunctions (eye teaming problems)
Ocular Motility Dysfunctions (eye tracking problems
Strabismus (turned eye)
Amblyopic (lazy eye)
Adler, P. (2002). Efficacy of treatment for convergence insufficiency using vision therapy. Ophthalmic and Physiological Optics, 22, 565-571.
Cirigliano, Suzette. Glossary of Vision Terms. http://www.vision-therapy.com/Glossary_of_Terms.htm 9/22/2003
Cirigliano, Suzette. (2003). Research studies about vision therapy treatment. http://www.vision-therapy.com/vt_research_studies.htm 9/22/2003
Coffey, B., Wick, B., Cotter, S., Scharre, J., & Horner, D. (1992). Treatment options in intermittent exotropia: a critical appraisal. Optometry of Visual Science, 69, 386-404.
Glackin, Stella. (1990). The office eye workout; here’s how to ensure that your VDT doesn’t come to stand for Vision Destroying Terminal. East West, 20, 60.
Learning disabilities, dyslexia, and vision: a subject review. (1998). Pediatrics, 102, 1217.
Optometrists Network. http://www.children-special-needs.org/questions_pf.html 9/22/2003
Press, L. J. Vision therapy FAQs. http://www.visiontherapy.org/vision-therapy/faqs/vision-therapy-FAQs.html 9/22/2003
Rouse, M. W. (1987). Management of binocular anomalies: efficacy of vision therapy in the treatment of accommodative deficiencies. American Journal of Physiological Optometry, 64, 415-420.
Simons, H. D., & Grisham, J.D. (1987). Binocular anomalies and reading problems. Journal of American Optometry Association, 58, 578-87.
Toufexis, A. (1989). Workouts for the eyes; therapies to improve visual performance get mixed reviews. Time, 133, 86.
Verma, A., & Singh, D. (1997). Active vision therapy for pseudophakic amblyopic. Journal of Cataract and Refractive Surgery, 23, 1089-1094.
Vision for life. (2002). Our program for rebuilding your vision naturally. http://www.rebuildyourvision.com/our_program.htm 9/22/2003
Yoga. (2002). Eye exercises. http://www.holistic-online.com/yoga/hol_yoga_pos_eyeex.htm 9/22/2003
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