Vision therapy, also known as visual therapy or visual training, is a broadly-defined set of treatment programs related to the improvement of visual health and comfort. Probably, the best known form of vision therapy is orthoptics which treats binocular vision disorders such as amblyopia, strabismus, and double vision or diplopia. Other problems treated with vision therapy include difficulties of visual attention and concentration, which are said to manifest as an inability to sustain focus or to shift focus from one area of space to another. The ability to shift the focus of visual attention from one place in space to another is also a critical developed visual ability that affects many aspects of life including reading, most vocations and most avocations. Eye doctors may also prescribe vision therapy to victims of strokes, concussions, and head injuries, as well as sufferers from eye strain and visually-induced headaches. However, not all such therapy is limited to disorders of the visual system. Professional athletes, for example, may use vision therapy to enhance peripheral vision on the playing field or increase responsiveness to fast moving objects.

History

The concept of vision therapy was introduced in the late nineteenth century for the non-surgical treatment of misaligned eyes. This early form of vision therapy is what is now known as orthoptics. Collaboration of eye care professionals with educators and neuroscientists produced an expansion of vision therapy into the treatment of other eye teaming (binocular) deficits (the use of the flow through the right and left eyes simultaneously to the brain) as well as dysfunctions in visual focusing, perception, tracking and motor skills.

As a result of this expansion and ensuing confusion over what the term "vision therapy" includes, there is some controversy as to the use of vision therapy for individuals with learning disorders. Vision therapy is not a treatment for learning disorders of any kind. Rather, vision therapy treats underlying visual problems which, when present, can negatively affect learning potential and reading acquisition and practice.

Scientific support for vision therapy

In 1988, a review of 238 scientific articles was published in the Journal of the American Optometric Association defining vision therapy as "a clinical approach for correcting and ameliorating the effects of eye movement disorders, non-strabismic binocular dysfunctions, focusing disorders, strabismus, amblyopia, nystagmus, and certain visual perceptual (information processing) disorders." The paper contains the concluding statement, "It is evident from the research that there is scientific support for the efficacy of vision therapy in modifying and improving ocumolotor, accommodative, and binocular system disorders, as measured by standardized clinical and laboratory testing methods for patients of all ages for whom it is properly undertaken and employed."

Very recently (2005), the Convergence Insufficency Treatment Trial (CITT) published two large, randomized clincal studies. The first demonstrated that in-office vision therapy was more effective than "pencil pushups" (a commonly prescribed home-based treatment) for the treatment of convergence insufficiency in 9 to 18 year old children. The second study published found similar results for adults 19 to 30 years of age .

Skepticism

Many critics of vision therapy emphasize a distinction between "eye exercises" and "vision therapy." In these arguments, "eye exercises" are performed for treatment of classically-recognized conditions and associated symptoms directly attributable to the oculomotor system (convergence insufficiency, intermittent exotropia, etc.). Reputable (published in peer-reviewed journals) critics only rarely challenge the effectiveness of vision therapy in these areas of treatment, and then only for specific instances. Therapy activities other than traditional orthoptics, usually lumped together under the term "vision therapy", are challenged based on their use, according to critics, for treatment of such problems as dyslexia or other learning disorders. The use of eye exercises or other forms of vision therapy to alter refractive conditions (myopia) has also been widely challenged.

In 1998, the American Academy of Pediatrics, American Academy of Ophthalmology, and American Association for Pediatric Ophthalmology and Strabismus issued a policy statement regarding the use of vision therapy specifically for the treatment of learning problems and dyslexia. According to the statement: "No scientific evidence exists for the efficacy of eye exercises ('vision therapy')... in the remediation of these complex pediatric neurological conditions."

References

• The 1986/1987 Future of Visual Development/Performance Task Force. Special Report: The efficacy of optometric vision therapy. J Am Optom Assoc 1988;59:95-105
• Scheiman M, Mitchell GL, Cotter S, Cooper J, Kulp M, Rouse M, Borsting E, London R, Wensveen J; Convergence Insufficiency Treatment Trial Study Group. "A randomized clinical trial of treatments for convergence insufficiency in children." Arch Ophthalmol. 2005 Jan;123(1):14-24. PMID 15642806
• Scheiman M, Mitchell GL, Cotter S, Kulp MT, Cooper J, Rouse M, Borsting E, London R, Wensveen J. "A randomized clinical trial of vision therapy/orthoptics versus pencil pushups for the treatment of convergence insufficiency in young adults." Optom Vis Sci. 2005 Jul;82(7):583-95. PMID 16044063
• American Academy of Pediatrics, American Association for Pediatric Ophthalmology and Strabismus, American Academy of Ophthalmology. "Policy Statement: Learning Disabilities, Dyslexia, and Vision" September, 1998.
• Worrall, R; Nevyas, J; Barrett, S. "Eye-Related Quackery". August, 2003.

See also

• College of Optometrists in Vision Development
• Optometric Extension Program

External links

• 100s of Treatment Stories by Patients, Parents and Teachers
• Optometrists Network
• Neuro-Optometric Rehabilitation Association
• American Academy of Ophthalmology
• American Academy of Pediatric Ophthalmology & Strabismus
• Parents Active for Vision Education
• Vision Therapy Sceptics
• References, Research, Studies: Vision Therapy
• What is Vision Therapy?

Vision | Therapy | Optometry