Q&A - Let Dr. Ashe answer your Vision Therapy questions
Does vision therapy help with lazy eye and wandering eye (strabismus)?
Many times a “lazy” or “wandering” eye (strabismus or eye turn) is a learned behavior, and can be due to a number of different factors. One of the most common factors for the development of strabismus includes a large amount of uncorrected (no glasses or contact lenses) farsightedness (hyperopia), which can sometimes manifest as an eye turn in towards the nose.
Another common cause of strabismus occurs when a person is unable to coordinate the two eyes to work together as a team, which can lead to an eye turn out or pointing the eyes farther away than the actual object’s position. Since Vision Therapy teaches a person how to use their visual system more efficiently, a “lazy” or “wandering” eye (strabismus) can be managed successfully with vision therapy.
Are “orthoptics” and “vision therapy” the same thing?
Orthoptics and vision therapy have similarities and differences. Both orthoptics and vision therapy are non-surgical approaches to the management of conditions such as amblyopia and double vision. Both work to manage mis-aligned eyes, and may also include the use of patches and prisms.
However, the way in which these tools are used in management tend to differ. In orthoptics, patches, prisms, lenses and sometimes drops are used in more of a passive manner. For example, a patient in Charlotte may wear an eye patch for a certain number of hours per day, or may even have prism or lenses that they wear for varying conditions. In essence, orthoptics acts as more of a passive band aid to straighten the eyes.
In vision therapy, patches, prisms, lenses and other tools tend to be used actively as a part of therapeutic activities in-office. Vision therapy at our Charlotte Vision Center includes orthoptic principles, but extends far past just alignment of the eyes. Orthoptics is concerned with simply straightening the eyes, whereas, vision therapy is concerned with not only eye alignment, but eye teaming and how a person’s eyes, brain and body interact together as one system.
What should patients or parents keep in mind while researching vision therapy on the Internet?
It is best to try and ensure that you are using reputable sources when researching vision therapy. Optometric websites and publications are recommended. Some of the better sources include:
- The American Optometric Association (aoa.org)
- College of Optometrists in Vision Development (covd.org)
- Optometric Extension Program (oepf.org)
If you would like to read a more personal account on the efficacy of vision therapy, read Jillian’s Story How Vision Therapy Changed my Daughter’s Life by Robin Benoit (jilliansstory.com).
Why would some ophthalmologists claim that vision therapy doesn’t work?
Some ophthalmologists (medical doctors who perform eye surgeries) may say that vision therapy does not work for several reasons. Remember, vision therapy is a non-surgical approach to the management of many common visual conditions. The first may simply be that the ophthalmologist does not gain monetarily if they do not perform an eye surgery. Another reason for ophthalmology to discredit vision therapy may be that there is ignorance of the benefits of non-surgical therapy due to a lack of specific training. Many ophthalmologists know very little regarding visual perception and integration, binocular vision and vision therapy because their curriculum does not cover such topics. Ophthalmologists are highly skilled in the areas of eye disease and eye surgery.
Can orthoptics or vision therapy help with learning problems?
Vision therapy in our Charlotte, NC Vision Center can help with learning problems. Many children with a learning disability may also have visual problems. Those visual problems may extend past the need for just glasses or contact lenses. Vision therapy is not a cure for learning problems, and works best in conjunction with a myriad of different disciplines (i.e. Speech therapy, Occupational therapy, Individualized Education Plans through school, etc.) Vision therapy does not diagnose nor treat learning disabilities such as dyslexia or attention deficit disorder (ADD). Vision therapy works to improve the function of an educationally interfering visual system.
Is there scientific evidence that vision therapy works?
There are many bodies of scientific research justifying the efficacy of vision therapy. A few of the more popular examples of scientific evidence are:
- Mitchell Scheiman, OD; Susan Cotter, OD, MS; G. Lynn Mitchell, MAS; Marjean Kulp, OD, MS; Michael Rouse, OD, MEd; Richard Hertle, MD; and Maryann Redford, DDS, MPH. Randomized Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children. Archives of Ophthalmology, Vol. 126 No. 10, October 2008
- Maples WC. Visual factors that significantly impact academic performance. Optometry 2003; 4:35-49.
- Ciuffreda, Kenneth J. The Scientific Basis for and Efficacy of Optometric Vision Therapy in Nonstrabismic Accommodative and Vergence Disorders. Optometry 2002; 73:735-62.
- A Joint Organizational Policy Statement of The American Academy of Optometry and the American Optometric Association. Vision Therapy: Information for Health Care and Other Allied Professionals. 1999
- A Joint Organizational Policy Statement of the American Academy of Optometry and the American Optometric Association. Vision, Learning, and Dyslexia. 1997.
What’s the position of educators regarding vision therapy?
The position of educators on the topic of vision therapy varies greatly. Educators in Charlotte tend to be aware of symptoms or signs that a child may need glasses or contact lenses. However, typically little to nothing is known about the 17 visual skills that a child needs to be able to perform accurately for optimal learning in the classroom. Educators that possess more knowledge regarding vision therapy and its efficacy may have a more positive view. Many teachers have had students in their classrooms who have successfully completed programs of vision therapy, and can speak to its success. Resources in the school system tend to be limited; therefore, many educators may not have an opinion on vision therapy.
Can special colored lenses or filters be used instead of vision therapy?
Colored lenses or filters are not substitutes for vision therapy. In some cases, colored lenses or filters may be used within therapeutic activities to achieve specific goals.
Does insurance pay for vision therapy?
Some insurances pay for vision therapy. Keep in mind, however, that we live in a time where insurance companies are trying to cut costs. This can result in inadequate coverage for vision therapy by insurance. Parents and patients may receive more coverage or reimbursement by submitting their claims directly.
Is it true that there are certain conditions, like lazy eye, where the patient is too old, or it’s too late to intervene with vision therapy?
In my opinion, a patient is never too old to gain the benefits of vision therapy if they are motivated to improve their visual system and have realistic visual skills goals.
How long does Vision therapy last for?
The duration of a vision therapy program varies and is individualistic to the patient. On average, a minimum of 24 to 48 sessions is recommended by most professionals. This can be more or less because vision therapy programs are tailored specifically to a patient, their performance and motivation, and their visual system goals.
Can vision therapy be done at home on the computer?
Yes. Vision therapy can be done at home on the computer; however, there are limitations. The best success occurs when a patient engages with in-office vision therapy one to two times per week, and practices their visual skills through learned activities the rest of the week. Some of these activities are on the computer, while others are not. It is important to note that people interact with not only computers/electronics but space in general as well.
Why don’t all optometrists do vision therapy?
Optometry, like many career paths, can be divided into subspecialties or categories such as vision therapy, ocular disease, primary care, primary pediatrics and low vision. Some optometrists prefer to focus clinically on specific subspecialties due to their own personal interest and skill level. Thus, not all optometrists practice vision therapy and you should call a specialist like the optometrists at Complete Eye Care.
Is vision therapy helpful for athletes? What is sports vision therapy?
Vision therapy can be extremely helpful for athletes. Many high performing athletes possess a relatively efficient visual system. Sports vision therapy can help athletes improve the function of their visual system through a series of activities and exercises that not only simulate the athlete’s particular sport, but also challenge and enhance the athlete’s visual skills while engaging in said sport. Athletes who have suffered a concussion may also benefit from rehabilitative vision therapy. Essentially, the athlete re-learns visual skills to improve their visual system after injury to the head.
Does vision therapy help with visual symptoms that results from traumatic brain injury, whiplash, stroke, and head injuries?
Vision therapy helps with visual symptoms resulting from events such as stroke, head injuries and traumatic brain injuries. Many times, after such events, a person can have problems ranging from eye teaming issues to double vision. Vision therapy helps to improve such symptoms with specifically designed activities to enhance visual skills that may have been lost.
Can vision therapy help people with developmental disabilities such as autism?
Vision therapy can help people with developmental delays and special needs such as Autism by enhancing eye teaming, fixation and visual perceptual abilities. Because vision therapy is tailored to that specific person, the therapy activities can be modified to achieve visual goals. Combined therapies from multi-disciplinary sources, such as speech therapy and occupational therapy, with vision therapy can produce good results.
How do I know if my child’s school issues require vision therapy?
If your child is struggling in school, schedule a comprehensive eye health and vision exam with an optometrist. This initial eye exam can detect eye diseases, the need for correction (i.e. glasses, contact lenses), and other signs that could necessitate further in-depth testing. If your child’s eye health and visual acuity (ability to see fine detail) are good, but other signs related to learning problems are found, it may be recommended for the child to have additional and more in-depth testing to uncover specific inefficient visual skills. Keep in mind that ALL optometrists do not perform specific testing as it relates to learning. It is best to work with an optometrist who has studied pediatric eye care and visual development.
What is the success rate of vision therapy?
The success rate of vision therapy varies from person to person. This is due to a number of different factors including the status of the person’s visual system, how motivated the person is while performing in-office vision therapy, and how motivated the person is while practicing home vision therapy shown to them in-office. The best success rates for vision therapy have been reported by those motivated individuals who participate in in-office vision therapy at least once per week, and perform their home therapy as instructed. I expect to see an improvement in symptoms after approximately 8 to 12 vision therapy sessions, if the person is dedicated and motivated.
Does vision therapy help with reading issues?
Certain visual skills are needed in reading. These include but are not limited to the ability to see fine detail, and efficient eye teaming and eye movements. Quick eye movements, called saccades, are necessary in reading. If your child is not able to perform these visual skills well, reading and reading comprehension can suffer. Fortunately, vision therapy can help teach or improve necessary reading visual skills through a series of specifically designed activities.
What age should my child begin vision therapy?
Vision therapy can be performed with a wide range of ages. There is no set rule as to when a person can begin vision therapy; however, it is best that the person is motivated to improve their visual skills. If you’re not sure if your child is old enough to begin vision therapy, talk with an optometrist who does vision therapy for more information. Many vision therapy activities can be modified to fit the age level of the patient.
I saw an online vision therapy program, does it work?
Online vision therapy programs are a great tool; however, patients gain the most success with in-office vision therapy that is practiced at home. Vision therapy activities practiced at home can range from computer programs to the use of specific equipment. The in-office vision therapy session allows patients to be taught how to use their visual system more efficiently with one on one guidance, and tends to be more interactive than a computer program.