The Case for Vision Therapy
By Jesse Willingham, O.D.
“Why have I never heard of this?” is one of the most common questions I get from parents who’ve come to us and are excited to finally feel like they’ve found someone to help their kid overcome their struggles and meet their potential.
“What’s the evidence this will work?” is the next most common, from understandably skeptical parents. A program of care with a developmental optometrist is a significant investment of time and funds for most families, and they want to know that they’re making a wise decision with this investment.
In the Information Age, patients and parents no longer feel satisfied to trust the professional, because the resources for information at their fingertips are endless. No one needs to only trust a single opinion with access to information like that. But buyer beware, it doesn’t take anyone very long to find dozens of opinions for or against nearly any subject you research.
So, what does the information say about vision therapy?
The American Optometric Association is the ultimate organization for identifying the minimum standard anyone should expect from a doctor of optometry. This organization publishes multiple practice guidelines, publically available, to guide optometrists to the best known evidence-based treatments for the major conditions optometrists manage.
Among these, vision therapy is considered among the primary methods of treatment, in conjunction with the appropriate application of prescription lenses, prisms, eyedrops, and surgery, for several conditions, including amblyopia, strabismus, and disorders of accommodation and vergence. This is not a fringe group or alternative opinion, but the primary, evidence and consensus based opinion of the leaders in the field.
Why then might some education and medical professionals advise against vision therapy? The primary reason is lack of knowledge. Medical and education professionals receive no training in the theory and practice of vision therapy. They should be no more expected to provide expert opinion on the matter than an optometrist would be expected to provide expert opinion on heart surgery. However, there is arguably more overlap in their fields and vision therapy, so let’s give their position closer consideration.
Ophthalmologists are medical doctors who specialize in the allopathic treatment of diseases of the eyes and their surrounding structures. This means the tools an ophthalmologist uses are primary drugs and surgery, with some application of lenses. Their training generally does not include remediation or rehabilitation of visual dysfunction.
This is the primary difference – ophthalmologists are primarily eye specialists, whereas optometrists are rooted in managing vision. The difference is subtle, but analogous to discussing the difference between hardware and software. This is why there are two different professions divided into computer engineers and software engineers – both the hardware and software are needed for the machine to function, but knowledge about one does not necessarily provide knowledge about the other.
Let’s continue this analogy into education. If vision is software, it’s like a major part of the operating system your computer is running on. Education, then, teaches us to use and upgrades all the programs that run on that operating system. Teachers are then working on a level separate from vision specialists – they have to assume the operating system is intact, and it is up to the vision specialist to both get vision up to snuff to function properly for learning as well as to communicate with the educator any accommodations the child might need to help the while their operating system is being upgraded.
As a developmental optometrist, surgeons and educators are an essential part of the team that ultimately gets the child where they need to be. My job is to teach the visual system to operate to its full capacity so it can readily engage with what the teacher is conveying. I then refer to the surgeon if the visual system needs help with alignment that is practically achieved through special prism lenses or internal effort. Unfortunately, the team approach is not always recognised or welcomed. Many teachers are already overwhelmed and overburdened by the education system – it is not their responsibility to detect these types of vision problems. However, every good teacher is going to communicate to a parent when their child is falling behind.
It then needs to become a cultural norm that the parent finds a developmental optometrist at that point as part of the overall investigation into how to help the child catch up. A history of economic competition has unfortunately driven a wedge between optometrists and ophthalmologists, but as roles change this divide is growing narrower, with more collaboration happening between the two groups every day, to the benefit of all patients.
I hope the above addresses the root of the controversy over vision therapy. For information about the evidence of vision therapy, there are public access journals and articles spanning decades to give an overview of the science of vision therapy. The doctors educated in the field and contributing to this body of scientific literature, including myself, are happy to share our expertise with you if desired.
So if you are googling, is vision therapy good/will vision therapy work/how does vision therapy work – connect with us. We can discuss vision therapy in general and what has led you individually down this path.
More research on vision therapy
Convergence Insufficiency Treatment Trial Investigator Group
Interventions for convergence insufficiency: a network meta-analysis (Review, 2020)
Scheiman M, Kulp MT, Cotter SA, Lawrenson JG, Wang L, Li T
Convergence insufficiency–a major review (2012)
Jeffrey Cooper, M.S., O.D., and Nadine Jamal, O.D.
Visual and binocular status in elementary school children with a reading problem (2017)
Lisa W. Christian, Krithika Nandakumar, Patricia K. Hrynchak, Elizabeth L. Irving
Vision Therapy for Post-Concussion Vision Disorders (2016)
Gallaway, Michael; Scheiman, Mitchell; Mitchell, G. Lynn
A Randomized Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children (2009)
Convergence Insufficiency Treatment Trial Investigator Group
Association between reading speed, cycloplegic refractive error, and oculomotor function in reading disabled children versus controls (2013)
Quaid, Patrick; Simpson, Trefford
Improvement in academic behaviors after successful treatment of convergence insufficiency (2012)
Borsting E, Mitchell GL, Kulp MT, Scheiman M, Amster DM, Cotter S, Coulter RA, Fecho G, Gallaway MF, Granet D, Hertle R, Rodena J, Yamada T; CITT Study Group.
The Relationship between Convergence Insufficiency and ADHD (2005)
David B. Granet Department of Ophthalmology, Ratner Children’s Eye Center, University of California, San Diego, CA, USA , MD FACS FAAO FAAP, Cintia F. Gomi , MD, Ricardo Ventura , MD & Andrea Miller-Scholte , CO
The Effect of Saccadic Training on Early Reading Fluency (2014)
Danielle F. Leong, OD, Christina L. Master, MD, Leonard V. Messner, OD, Yi Pang, OD, MD, PhD, Craig Smith, MD, Amaal J. Starling, MD
Traumatic Brain Injury: Visual Consequences, Diagnosis, and Treatment (2016)
Kenneth J. Ciuffreda, OD, PhD, Diana P. Ludlam, BS, COVT, Naveen K. Yadav, BS Optom, MS, PhD, Preethi Thiagarajan, BS Optom, MS, PhD
Screening for lifetime concussion in athletes: importance of oculomotor measures (2014)
Poltavski DV1, Biberdorf D
Article 4 An exploratory study of the potential effects of vision training on concussion incidence in football (2015)
Clark, Joseph & Graman, Pat & K Ellis, James & Mangine, Robert & T Rauch, Joseph & Bixenmann, Ben & Hasselfeld, Kimberly & Divine, Jon & Colosimo, Angelo & Myer, Gregory.
Uncorrected Hyperopia and Preschool Early Literacy: Results of the Vision in Preschoolers-Hyperopia in Preschoolers (VIP-HIP) Study (2016)
VIP-HIP Study Group, Kulp MT, Ciner E, Maguire M, Moore B, Pentimonti J, Pistilli M, Cyert L, Candy TR, Quinn G, Ying GS.
Is visual memory predictive of below-average academic achievement in second through fourth graders? (2002)
Kulp MT, Edwards KE, Mitchell GL.
Frequency of Visual Deficits in Children With Developmental Dyslexia (2018)
Aparna Raghuram, OD, PhD; Sowjanya Gowrisankaran, PhD; Emily Swanson, BS; David Zurakowski, MS, PhD; David G. Hunter, MD, PhD; Deborah P. Waber, PhD
Healio coverage of this article: Significant correlation found between visual deficits, dyslexia
A Pilot Investigation of Visual Pathways in Patients with Mild Traumatic Brain Injury
Paul Harris 1 and Mark H. Myers 2,*
Department of Vision Therapy, Southern College of Optometry, Memphis, TN 38104, USA 2 Department of Anatomy and Neurobiology, University of Tennessee Health Sciences Center, Memphis, TN 38163, USA
Literature Summaries
Compiled by Student and Resident Members for the Annual Meeting Travel Grant Program
A Summary of Research and Clinical Studies on Vision and Learning
Research Update on Visually-Based Reading Disability (2011)
Barry Tannen, OD, FCOVD
Optometric Vision Therapy in Rehabilitation of Cognitive Deficit Secondary to Traumatic Brain Injury (2007)
Tanya Skaler and Amanda Bowens
A Discussion and Analysis, in the context of current research to May 2016, of: A critical evaluation of the evidence supporting the practice of behavioural vision therapy
Leonard J Press, OD, FCOVD, FAAO
Mark Overton, B.App.Sci, MBA
Stephen Leslie, B Optom, FACBO, FCOVD, Ophthalmic Medicines Prescriber
The Australasian College of Behavioural Optometrists
At Brighter Outlook Vision, we help improve people’s vision so they can more fully engage in their life. If you have a child struggling to read, it could be a vision problem that could be corrected with vision therapy. We can also help young athlete’s improve their vision and speed up their reaction times. Learn more about who we can help or give us a call at 843-203-0200 and we can hear what you are dealing with to see if vision could be at the root of the problem.
